hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|OH,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Highland District Hospital,2024-06-26,2.0.0,Highland District Hospital,"1275 N High St, Hillsboro, OH 45133",310653685,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,modifiers,standard_charge|Aetna|Commercial|negotiated_dollar,standard_charge|Aetna|Commercial|negotiated_percentage,standard_charge|Aetna|Commercial|negotiated_algorithm,estimated_amount|Aetna|Commercial,standard_charge|Aetna|Commercial|methodology,additional_payer_notes|Aetna|Commercial,standard_charge|Aetna_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|Aetna_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|Aetna_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|Aetna_MEDICARE|MEDICARE,standard_charge|Aetna_MEDICARE|MEDICARE|methodology,additional_payer_notes|Aetna_MEDICARE|MEDICARE,standard_charge|ANTHEM_BLUE_ACCESS|commercial|negotiated_dollar,standard_charge|ANTHEM_BLUE_ACCESS|commercial|negotiated_percentage,standard_charge|ANTHEM_BLUE_ACCESS|commercial|negotiated_algorithm,estimated_amount|ANTHEM_BLUE_ACCESS|commercial,standard_charge|ANTHEM_BLUE_ACCESS|commercial|methodology,additional_payer_notes|ANTHEM_BLUE_ACCESS|commercial,standard_charge|ANTHEM_BLUE_PREFERRED|commercial|negotiated_dollar,standard_charge|ANTHEM_BLUE_PREFERRED|commercial|negotiated_percentage,standard_charge|ANTHEM_BLUE_PREFERRED|commercial|negotiated_algorithm,estimated_amount|ANTHEM_BLUE_PREFERRED|commercial,standard_charge|ANTHEM_BLUE_PREFERRED|commercial|methodology,additional_payer_notes|ANTHEM_BLUE_PREFERRED|commercial,standard_charge|ANTHEM_DUAL|MEDICARE|negotiated_dollar,standard_charge|ANTHEM_DUAL|MEDICARE|negotiated_percentage,standard_charge|ANTHEM_DUAL|MEDICARE|negotiated_algorithm,estimated_amount|ANTHEM_DUAL|MEDICARE,standard_charge|ANTHEM_DUAL|MEDICARE|methodology,additional_payer_notes|ANTHEM_DUAL|MEDICARE,standard_charge|ANTHEM_MEDICAID|MEDICAID|negotiated_dollar,standard_charge|ANTHEM_MEDICAID|MEDICAID|negotiated_percentage,standard_charge|ANTHEM_MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|ANTHEM_MEDICAID|MEDICAID,standard_charge|ANTHEM_MEDICAID|MEDICAID|methodology,additional_payer_notes|ANTHEM_MEDICAID|MEDICAID,standard_charge|ANTHEM_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|ANTHEM_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|ANTHEM_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|ANTHEM_MEDICARE|MEDICARE,standard_charge|ANTHEM_MEDICARE|MEDICARE|methodology,additional_payer_notes|ANTHEM_MEDICARE|MEDICARE,standard_charge|ANTHEM_PATHWAY_HMO|commercial|negotiated_dollar,standard_charge|ANTHEM_PATHWAY_HMO|commercial|negotiated_percentage,standard_charge|ANTHEM_PATHWAY_HMO|commercial|negotiated_algorithm,estimated_amount|ANTHEM_PATHWAY_HMO|commercial,standard_charge|ANTHEM_PATHWAY_HMO|commercial|methodology,additional_payer_notes|ANTHEM_PATHWAY_HMO|commercial,standard_charge|ANTHEM_PATHWAY_PPO|commercial|negotiated_dollar,standard_charge|ANTHEM_PATHWAY_PPO|commercial|negotiated_percentage,standard_charge|ANTHEM_PATHWAY_PPO|commercial|negotiated_algorithm,estimated_amount|ANTHEM_PATHWAY_PPO|commercial,standard_charge|ANTHEM_PATHWAY_PPO|commercial|methodology,additional_payer_notes|ANTHEM_PATHWAY_PPO|commercial,standard_charge|ANTHEM_PATHWAY_X_HMO|commercial|negotiated_dollar,standard_charge|ANTHEM_PATHWAY_X_HMO|commercial|negotiated_percentage,standard_charge|ANTHEM_PATHWAY_X_HMO|commercial|negotiated_algorithm,estimated_amount|ANTHEM_PATHWAY_X_HMO|commercial,standard_charge|ANTHEM_PATHWAY_X_HMO|commercial|methodology,additional_payer_notes|ANTHEM_PATHWAY_X_HMO|commercial,standard_charge|ANTHEM_PATHWAY_X_PPO|commercial|negotiated_dollar,standard_charge|ANTHEM_PATHWAY_X_PPO|commercial|negotiated_percentage,standard_charge|ANTHEM_PATHWAY_X_PPO|commercial|negotiated_algorithm,estimated_amount|ANTHEM_PATHWAY_X_PPO|commercial,standard_charge|ANTHEM_PATHWAY_X_PPO|commercial|methodology,additional_payer_notes|ANTHEM_PATHWAY_X_PPO|commercial,standard_charge|ANTHEM_SMALL_GROUP_HMO|commercial|negotiated_dollar,standard_charge|ANTHEM_SMALL_GROUP_HMO|commercial|negotiated_percentage,standard_charge|ANTHEM_SMALL_GROUP_HMO|commercial|negotiated_algorithm,estimated_amount|ANTHEM_SMALL_GROUP_HMO|commercial,standard_charge|ANTHEM_SMALL_GROUP_HMO|commercial|methodology,additional_payer_notes|ANTHEM_SMALL_GROUP_HMO|commercial,standard_charge|ANTHEM_TRADITIONAL|commercial|negotiated_dollar,standard_charge|ANTHEM_TRADITIONAL|commercial|negotiated_percentage,standard_charge|ANTHEM_TRADITIONAL|commercial|negotiated_algorithm,estimated_amount|ANTHEM_TRADITIONAL|commercial,standard_charge|ANTHEM_TRADITIONAL|commercial|methodology,additional_payer_notes|ANTHEM_TRADITIONAL|commercial,standard_charge|BUCKEYE_MEDICAID|MEDICAID|negotiated_dollar,standard_charge|BUCKEYE_MEDICAID|MEDICAID|negotiated_percentage,standard_charge|BUCKEYE_MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|BUCKEYE_MEDICAID|MEDICAID,standard_charge|BUCKEYE_MEDICAID|MEDICAID|methodology,additional_payer_notes|BUCKEYE_MEDICAID|MEDICAID,standard_charge|BUCKEYE_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|BUCKEYE_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|BUCKEYE_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|BUCKEYE_MEDICARE|MEDICARE,standard_charge|BUCKEYE_MEDICARE|MEDICARE|methodology,additional_payer_notes|BUCKEYE_MEDICARE|MEDICARE,standard_charge|CARESOURCE_MEDICAID|MEDICAID|negotiated_dollar,standard_charge|CARESOURCE_MEDICAID|MEDICAID|negotiated_percentage,standard_charge|CARESOURCE_MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|CARESOURCE_MEDICAID|MEDICAID,standard_charge|CARESOURCE_MEDICAID|MEDICAID|methodology,additional_payer_notes|CARESOURCE_MEDICAID|MEDICAID,standard_charge|CENTRAL_BENEFITS_COMMERCIAL|commercial|negotiated_dollar,standard_charge|CENTRAL_BENEFITS_COMMERCIAL|commercial|negotiated_percentage,standard_charge|CENTRAL_BENEFITS_COMMERCIAL|commercial|negotiated_algorithm,estimated_amount|CENTRAL_BENEFITS_COMMERCIAL|commercial,standard_charge|CENTRAL_BENEFITS_COMMERCIAL|commercial|methodology,additional_payer_notes|CENTRAL_BENEFITS_COMMERCIAL|commercial,standard_charge|CIGNA|commercial|negotiated_dollar,standard_charge|CIGNA|commercial|negotiated_percentage,standard_charge|CIGNA|commercial|negotiated_algorithm,estimated_amount|CIGNA|commercial,standard_charge|CIGNA|commercial|methodology,additional_payer_notes|CIGNA|commercial,standard_charge|HIGHLAND_COUNTY_SHERIFF_DEPT|MEDICAID|negotiated_dollar,standard_charge|HIGHLAND_COUNTY_SHERIFF_DEPT|MEDICAID|negotiated_percentage,standard_charge|HIGHLAND_COUNTY_SHERIFF_DEPT|MEDICAID|negotiated_algorithm,estimated_amount|HIGHLAND_COUNTY_SHERIFF_DEPT|MEDICAID,standard_charge|HIGHLAND_COUNTY_SHERIFF_DEPT|MEDICAID|methodology,additional_payer_notes|HIGHLAND_COUNTY_SHERIFF_DEPT|MEDICAID,standard_charge|HUMANA|commercial|negotiated_dollar,standard_charge|HUMANA|commercial|negotiated_percentage,standard_charge|HUMANA|commercial|negotiated_algorithm,estimated_amount|HUMANA|commercial,standard_charge|HUMANA|commercial|methodology,additional_payer_notes|HUMANA|commercial,standard_charge|HUMANA_MEDICAID|MEDICAID|negotiated_dollar,standard_charge|HUMANA_MEDICAID|MEDICAID|negotiated_percentage,standard_charge|HUMANA_MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|HUMANA_MEDICAID|MEDICAID,standard_charge|HUMANA_MEDICAID|MEDICAID|methodology,additional_payer_notes|HUMANA_MEDICAID|MEDICAID,standard_charge|HUMANA_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|HUMANA_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|HUMANA_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA_MEDICARE|MEDICARE,standard_charge|HUMANA_MEDICARE|MEDICARE|methodology,additional_payer_notes|HUMANA_MEDICARE|MEDICARE,standard_charge|IMMERGRUN_AMISH_PLAN|commercial|negotiated_dollar,standard_charge|IMMERGRUN_AMISH_PLAN|commercial|negotiated_percentage,standard_charge|IMMERGRUN_AMISH_PLAN|commercial|negotiated_algorithm,estimated_amount|IMMERGRUN_AMISH_PLAN|commercial,standard_charge|IMMERGRUN_AMISH_PLAN|commercial|methodology,additional_payer_notes|IMMERGRUN_AMISH_PLAN|commercial,standard_charge|MEDBEN|MEDICARE|negotiated_dollar,standard_charge|MEDBEN|MEDICARE|negotiated_percentage,standard_charge|MEDBEN|MEDICARE|negotiated_algorithm,estimated_amount|MEDBEN|MEDICARE,standard_charge|MEDBEN|MEDICARE|methodology,additional_payer_notes|MEDBEN|MEDICARE,standard_charge|MEDICAID|MEDICAID|negotiated_dollar,standard_charge|MEDICAID|MEDICAID|negotiated_percentage,standard_charge|MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|MEDICAID|MEDICAID,standard_charge|MEDICAID|MEDICAID|methodology,additional_payer_notes|MEDICAID|MEDICAID,standard_charge|MEDICAL_MUTUAL_COMMERCIAL|MEDICARE|negotiated_dollar,standard_charge|MEDICAL_MUTUAL_COMMERCIAL|MEDICARE|negotiated_percentage,standard_charge|MEDICAL_MUTUAL_COMMERCIAL|MEDICARE|negotiated_algorithm,estimated_amount|MEDICAL_MUTUAL_COMMERCIAL|MEDICARE,standard_charge|MEDICAL_MUTUAL_COMMERCIAL|MEDICARE|methodology,additional_payer_notes|MEDICAL_MUTUAL_COMMERCIAL|MEDICARE,standard_charge|MEDICAL_MUTUAL_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|MEDICAL_MUTUAL_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|MEDICAL_MUTUAL_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|MEDICAL_MUTUAL_MEDICARE|MEDICARE,standard_charge|MEDICAL_MUTUAL_MEDICARE|MEDICARE|methodology,additional_payer_notes|MEDICAL_MUTUAL_MEDICARE|MEDICARE,standard_charge|MEDICARE|MEDICARE|negotiated_dollar,standard_charge|MEDICARE|MEDICARE|negotiated_percentage,standard_charge|MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|MEDICARE|MEDICARE,standard_charge|MEDICARE|MEDICARE|methodology,additional_payer_notes|MEDICARE|MEDICARE,standard_charge|MEDIGOLD|MEDICARE|negotiated_dollar,standard_charge|MEDIGOLD|MEDICARE|negotiated_percentage,standard_charge|MEDIGOLD|MEDICARE|negotiated_algorithm,estimated_amount|MEDIGOLD|MEDICARE,standard_charge|MEDIGOLD|MEDICARE|methodology,additional_payer_notes|MEDIGOLD|MEDICARE,standard_charge|MOLINA_MEDICAID|MEDICAID|negotiated_dollar,standard_charge|MOLINA_MEDICAID|MEDICAID|negotiated_percentage,standard_charge|MOLINA_MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|MOLINA_MEDICAID|MEDICAID,standard_charge|MOLINA_MEDICAID|MEDICAID|methodology,additional_payer_notes|MOLINA_MEDICAID|MEDICAID,standard_charge|MOLINA_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|MOLINA_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|MOLINA_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|MOLINA_MEDICARE|MEDICARE,standard_charge|MOLINA_MEDICARE|MEDICARE|methodology,additional_payer_notes|MOLINA_MEDICARE|MEDICARE,standard_charge|OPTUM_UHC_VA|MEDICARE|negotiated_dollar,standard_charge|OPTUM_UHC_VA|MEDICARE|negotiated_percentage,standard_charge|OPTUM_UHC_VA|MEDICARE|negotiated_algorithm,estimated_amount|OPTUM_UHC_VA|MEDICARE,standard_charge|OPTUM_UHC_VA|MEDICARE|methodology,additional_payer_notes|OPTUM_UHC_VA|MEDICARE,standard_charge|UHC|commercial|negotiated_dollar,standard_charge|UHC|commercial|negotiated_percentage,standard_charge|UHC|commercial|negotiated_algorithm,estimated_amount|UHC|commercial,standard_charge|UHC|commercial|methodology,additional_payer_notes|UHC|commercial,standard_charge|min,standard_charge|max,additional_generic_notes
LOCAL ANESTHESIA EACH ADDITIONAL 15 MINS,500010,CDM,370,RC,,,Outpatient,,,15,12.75,,12.18,81.2,,,percent of total billed charges,81.2% of total billed charges,4.9,32.64,,,percent of total billed charges,32.64% of total billed charges,11.1,74,,,percent of total billed charges,74% of total billed charges,11.1,74,,,percent of total billed charges,74% of total billed charges,4.8,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,4.8,32,,,percent of total billed charges,32% of total billed charges,10.65,71,,,percent of total billed charges,71% of total billed charges,10.65,71,,,percent of total billed charges,71% of total billed charges,10.05,67,,,percent of total billed charges,67% of total billed charges,10.05,67,,,percent of total billed charges,67% of total billed charges,10.65,71,,,percent of total billed charges,71% of total billed charges,11.4,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,4.94,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,13.5,90,,,percent of total billed charges,90% of total billed charges,13.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,13.29,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,4.8,32,,,percent of total billed charges,32% of total billed charges,12,80,,,percent of total billed charges,80% of total billed charges,12,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,13.65,91,,,percent of total billed charges,91% of total billed charges,4.9,32.64,,,percent of total billed charges,32.64% of total billed charges,4.8,32,,,percent of total billed charges,32% of total billed charges,5.04,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,4.8,32,,,percent of total billed charges,32% of total billed charges,4.8,32,,,percent of total billed charges,32% of total billed charges,13.8,92,,,percent of total billed charges,92% of total billed charges,4.8,13.8,
REGIONAL ANESTHESIA EA ADDITIONAL 15 MIN,500008,CDM,370,RC,,,Outpatient,,,31,26.35,,25.17,81.2,,,percent of total billed charges,81.2% of total billed charges,10.12,32.64,,,percent of total billed charges,32.64% of total billed charges,22.94,74,,,percent of total billed charges,74% of total billed charges,22.94,74,,,percent of total billed charges,74% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,9.92,32,,,percent of total billed charges,32% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,20.77,67,,,percent of total billed charges,67% of total billed charges,20.77,67,,,percent of total billed charges,67% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,23.56,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,10.22,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,27.9,90,,,percent of total billed charges,90% of total billed charges,27.9,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,27.47,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,9.92,32,,,percent of total billed charges,32% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,28.21,91,,,percent of total billed charges,91% of total billed charges,10.12,32.64,,,percent of total billed charges,32.64% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,10.42,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,9.92,32,,,percent of total billed charges,32% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,28.52,92,,,percent of total billed charges,92% of total billed charges,9.92,28.52,
MAC ANESTHESIA EACH ADDITIONAL 15 MINUTE,500006,CDM,370,RC,,,Outpatient,,,38,32.3,,30.86,81.2,,,percent of total billed charges,81.2% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,12.16,32,,,percent of total billed charges,32% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,28.88,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,12.52,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,34.2,90,,,percent of total billed charges,90% of total billed charges,34.2,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,33.67,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,12.16,32,,,percent of total billed charges,32% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,34.58,91,,,percent of total billed charges,91% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,12.77,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,12.16,32,,,percent of total billed charges,32% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,34.96,92,,,percent of total billed charges,92% of total billed charges,12.16,34.96,
LOCAL ANESTHESIA FIRST 30 MINUTES,500009,CDM,370,RC,,,Outpatient,,,39,33.15,,31.67,81.2,,,percent of total billed charges,81.2% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,12.48,32,,,percent of total billed charges,32% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,29.64,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,12.85,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,34.55,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,12.48,32,,,percent of total billed charges,32% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,35.49,91,,,percent of total billed charges,91% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,13.1,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,12.48,32,,,percent of total billed charges,32% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,35.88,92,,,percent of total billed charges,92% of total billed charges,12.48,35.88,
GENERAL ANESTHESIA EA ADDITIONAL 15 MINS,500004,CDM,370,RC,,,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,14.4,41.4,
REGIONAL ANESTHESIA FIRST 30 MINUTES,500007,CDM,370,RC,,,Outpatient,,,90,76.5,,73.08,81.2,,,percent of total billed charges,81.2% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,28.8,32,,,percent of total billed charges,32% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,68.4,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,29.66,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,79.74,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,28.8,32,,,percent of total billed charges,32% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,81.9,91,,,percent of total billed charges,91% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,30.24,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,28.8,32,,,percent of total billed charges,32% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,82.8,92,,,percent of total billed charges,92% of total billed charges,28.8,82.8,
MAC ANESTHESIA FIRST 30 MINUTES,500005,CDM,370,RC,,,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,39.04,112.24,
GENERAL ANESTHESIA FIRST 30 MINS,500003,CDM,370,RC,,,Outpatient,,,150,127.5,,121.8,81.2,,,percent of total billed charges,81.2% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,48,32,,,percent of total billed charges,32% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,114,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,49.44,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,135,90,,,percent of total billed charges,90% of total billed charges,135,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,132.9,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,48,32,,,percent of total billed charges,32% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,136.5,91,,,percent of total billed charges,91% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,50.4,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,48,32,,,percent of total billed charges,32% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,138,92,,,percent of total billed charges,92% of total billed charges,48,138,
ENDOTRACHEAL INTUBATION EMERGENCY,5400057,CDM,410,RC,31500,HCPCS,Outpatient,,,375,318.75,,304.5,81.2,,,percent of total billed charges,81.2% of total billed charges,122.4,32.64,,,percent of total billed charges,32.64% of total billed charges,277.5,74,,,percent of total billed charges,74% of total billed charges,277.5,74,,,percent of total billed charges,74% of total billed charges,120,32,,,percent of total billed charges,32% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,120,32,,,percent of total billed charges,32% of total billed charges,266.25,71,,,percent of total billed charges,71% of total billed charges,266.25,71,,,percent of total billed charges,71% of total billed charges,251.25,67,,,percent of total billed charges,67% of total billed charges,251.25,67,,,percent of total billed charges,67% of total billed charges,266.25,71,,,percent of total billed charges,71% of total billed charges,285,76,,,percent of total billed charges,76% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,123.6,32.96,,,percent of total billed charges,32.96% of total billed charges,391.37,105,,,Fee Schedule,pays based on EAPG rates,337.5,90,,,percent of total billed charges,90% of total billed charges,337.5,90,,,percent of total billed charges,90% of total billed charges,372.73,100,,,Fee Schedule,pays based on EAPG rates,332.25,88.6,,,percent of total billed charges,88.6% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,120,32,,,percent of total billed charges,32% of total billed charges,300,80,,,percent of total billed charges,80% of total billed charges,300,80,,,percent of total billed charges,80% of total billed charges,372.73,100,,,Fee Schedule,pays based on EAPG rates,341.25,91,,,percent of total billed charges,91% of total billed charges,122.4,32.64,,,percent of total billed charges,32.64% of total billed charges,120,32,,,percent of total billed charges,32% of total billed charges,126,33.6,,,percent of total billed charges,33.6% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,120,32,,,percent of total billed charges,32% of total billed charges,120,32,,,percent of total billed charges,32% of total billed charges,345,92,,,percent of total billed charges,92% of total billed charges,120,391.37,
SUCTION ONLY,5400089,CDM,460,RC,31720,HCPCS,Outpatient,,,673,572.05,,546.48,81.2,,,percent of total billed charges,81.2% of total billed charges,219.67,32.64,,,percent of total billed charges,32.64% of total billed charges,498.02,74,,,percent of total billed charges,74% of total billed charges,498.02,74,,,percent of total billed charges,74% of total billed charges,215.36,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,215.36,32,,,percent of total billed charges,32% of total billed charges,477.83,71,,,percent of total billed charges,71% of total billed charges,477.83,71,,,percent of total billed charges,71% of total billed charges,450.91,67,,,percent of total billed charges,67% of total billed charges,450.91,67,,,percent of total billed charges,67% of total billed charges,477.83,71,,,percent of total billed charges,71% of total billed charges,511.48,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,221.82,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,605.7,90,,,percent of total billed charges,90% of total billed charges,605.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,596.28,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,215.36,32,,,percent of total billed charges,32% of total billed charges,538.4,80,,,percent of total billed charges,80% of total billed charges,538.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,612.43,91,,,percent of total billed charges,91% of total billed charges,219.67,32.64,,,percent of total billed charges,32.64% of total billed charges,215.36,32,,,percent of total billed charges,32% of total billed charges,226.13,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,215.36,32,,,percent of total billed charges,32% of total billed charges,215.36,32,,,percent of total billed charges,32% of total billed charges,619.16,92,,,percent of total billed charges,92% of total billed charges,215.36,619.16,
CAPILLARY BLOOD COLLECTION,5400090,CDM,460,RC,36416,HCPCS,Outpatient,,,72,61.2,,58.46,81.2,,,percent of total billed charges,81.2% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,54.72,76,,,percent of total billed charges,76% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,23.73,32.96,,,percent of total billed charges,32.96% of total billed charges,1.7,105,,,Fee Schedule,pays based on EAPG rates,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,63.79,88.6,,,percent of total billed charges,88.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,65.52,91,,,percent of total billed charges,91% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,24.19,33.6,,,percent of total billed charges,33.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,66.24,92,,,percent of total billed charges,92% of total billed charges,1.62,66.24,
ARTERIAL PUNCTURE,5400022,CDM,300,RC,36600,HCPCS,Outpatient,,,72,61.2,,58.46,81.2,,,percent of total billed charges,81.2% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,54.72,76,,,percent of total billed charges,76% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,23.73,32.96,,,percent of total billed charges,32.96% of total billed charges,23.1,105,,,Fee Schedule,pays based on EAPG rates,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,22,100,,,Fee Schedule,pays based on EAPG rates,63.79,88.6,,,percent of total billed charges,88.6% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,22,100,,,Fee Schedule,pays based on EAPG rates,65.52,91,,,percent of total billed charges,91% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,24.19,33.6,,,percent of total billed charges,33.6% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,66.24,92,,,percent of total billed charges,92% of total billed charges,22,66.24,
CALCIUM IONIZED,5400078,CDM,301,RC,82330,HCPCS,Outpatient,,,69,58.65,,56.03,81.2,,,percent of total billed charges,81.2% of total billed charges,22.52,32.64,,,percent of total billed charges,32.64% of total billed charges,51.06,74,,,percent of total billed charges,74% of total billed charges,51.06,74,,,percent of total billed charges,74% of total billed charges,22.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.08,32,,,percent of total billed charges,32% of total billed charges,48.99,71,,,percent of total billed charges,71% of total billed charges,48.99,71,,,percent of total billed charges,71% of total billed charges,46.23,67,,,percent of total billed charges,67% of total billed charges,46.23,67,,,percent of total billed charges,67% of total billed charges,48.99,71,,,percent of total billed charges,71% of total billed charges,52.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.74,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,62.1,90,,,percent of total billed charges,90% of total billed charges,62.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,61.13,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.08,32,,,percent of total billed charges,32% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,62.79,91,,,percent of total billed charges,91% of total billed charges,22.52,32.64,,,percent of total billed charges,32.64% of total billed charges,22.08,32,,,percent of total billed charges,32% of total billed charges,23.18,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.08,32,,,percent of total billed charges,32% of total billed charges,22.08,32,,,percent of total billed charges,32% of total billed charges,63.48,92,,,percent of total billed charges,92% of total billed charges,11.18,63.48,
VENOUS BLOOD GAS - pH ONLY,5400055,CDM,300,RC,82800,HCPCS,Outpatient,,,319,271.15,,259.03,81.2,,,percent of total billed charges,81.2% of total billed charges,104.12,32.64,,,percent of total billed charges,32.64% of total billed charges,236.06,74,,,percent of total billed charges,74% of total billed charges,236.06,74,,,percent of total billed charges,74% of total billed charges,102.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,102.08,32,,,percent of total billed charges,32% of total billed charges,226.49,71,,,percent of total billed charges,71% of total billed charges,226.49,71,,,percent of total billed charges,71% of total billed charges,213.73,67,,,percent of total billed charges,67% of total billed charges,213.73,67,,,percent of total billed charges,67% of total billed charges,226.49,71,,,percent of total billed charges,71% of total billed charges,242.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.14,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,287.1,90,,,percent of total billed charges,90% of total billed charges,287.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,282.63,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,102.08,32,,,percent of total billed charges,32% of total billed charges,255.2,80,,,percent of total billed charges,80% of total billed charges,255.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,290.29,91,,,percent of total billed charges,91% of total billed charges,104.12,32.64,,,percent of total billed charges,32.64% of total billed charges,102.08,32,,,percent of total billed charges,32% of total billed charges,107.18,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,102.08,32,,,percent of total billed charges,32% of total billed charges,102.08,32,,,percent of total billed charges,32% of total billed charges,293.48,92,,,percent of total billed charges,92% of total billed charges,11.18,293.48,
CORD VENOUS,5400072,CDM,300,RC,82800,HCPCS,Outpatient,,,331,281.35,,268.77,81.2,,,percent of total billed charges,81.2% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,251.56,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,109.1,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,293.27,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,301.21,91,,,percent of total billed charges,91% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,111.22,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,304.52,92,,,percent of total billed charges,92% of total billed charges,11.18,304.52,
CAPILLARY BLOOD GAS,5400054,CDM,300,RC,82803,HCPCS,Outpatient,,,319,271.15,,259.03,81.2,,,percent of total billed charges,81.2% of total billed charges,104.12,32.64,,,percent of total billed charges,32.64% of total billed charges,236.06,74,,,percent of total billed charges,74% of total billed charges,236.06,74,,,percent of total billed charges,74% of total billed charges,102.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,102.08,32,,,percent of total billed charges,32% of total billed charges,226.49,71,,,percent of total billed charges,71% of total billed charges,226.49,71,,,percent of total billed charges,71% of total billed charges,213.73,67,,,percent of total billed charges,67% of total billed charges,213.73,67,,,percent of total billed charges,67% of total billed charges,226.49,71,,,percent of total billed charges,71% of total billed charges,242.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.14,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,287.1,90,,,percent of total billed charges,90% of total billed charges,287.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,282.63,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,102.08,32,,,percent of total billed charges,32% of total billed charges,255.2,80,,,percent of total billed charges,80% of total billed charges,255.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,290.29,91,,,percent of total billed charges,91% of total billed charges,104.12,32.64,,,percent of total billed charges,32.64% of total billed charges,102.08,32,,,percent of total billed charges,32% of total billed charges,107.18,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,102.08,32,,,percent of total billed charges,32% of total billed charges,102.08,32,,,percent of total billed charges,32% of total billed charges,293.48,92,,,percent of total billed charges,92% of total billed charges,11.18,293.48,
ARTERIAL BLOOD GAS,5400007,CDM,300,RC,82803,HCPCS,Outpatient,,,331,281.35,,268.77,81.2,,,percent of total billed charges,81.2% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,251.56,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,109.1,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,293.27,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,301.21,91,,,percent of total billed charges,91% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,111.22,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,304.52,92,,,percent of total billed charges,92% of total billed charges,11.18,304.52,
CORD ARTERIAL,5400073,CDM,300,RC,82803,HCPCS,Outpatient,,,331,281.35,,268.77,81.2,,,percent of total billed charges,81.2% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,251.56,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,109.1,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,293.27,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,301.21,91,,,percent of total billed charges,91% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,111.22,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,304.52,92,,,percent of total billed charges,92% of total billed charges,11.18,304.52,
ABG W/ DIRECT MEASURE,5400091,CDM,301,RC,82805,HCPCS,Outpatient,,,73,62.05,,59.28,81.2,,,percent of total billed charges,81.2% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,55.48,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,24.06,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,64.68,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,66.43,91,,,percent of total billed charges,91% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,24.53,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,67.16,92,,,percent of total billed charges,92% of total billed charges,12.85,67.16,
SPUTUM INDUCTION INITIAL W/ TREATMENT,5400016,CDM,410,RC,89220,HCPCS,Outpatient,,,73,62.05,,59.28,81.2,,,percent of total billed charges,81.2% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,55.48,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,24.06,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,64.68,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,66.43,91,,,percent of total billed charges,91% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,24.53,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,67.16,92,,,percent of total billed charges,92% of total billed charges,20.71,67.16,
CPR,5400045,CDM,270,RC,92950,HCPCS,Outpatient,,,357,303.45,,289.88,81.2,,,percent of total billed charges,81.2% of total billed charges,116.52,32.64,,,percent of total billed charges,32.64% of total billed charges,264.18,74,,,percent of total billed charges,74% of total billed charges,264.18,74,,,percent of total billed charges,74% of total billed charges,114.24,32,,,percent of total billed charges,32% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,114.24,32,,,percent of total billed charges,32% of total billed charges,253.47,71,,,percent of total billed charges,71% of total billed charges,253.47,71,,,percent of total billed charges,71% of total billed charges,239.19,67,,,percent of total billed charges,67% of total billed charges,239.19,67,,,percent of total billed charges,67% of total billed charges,253.47,71,,,percent of total billed charges,71% of total billed charges,271.32,76,,,percent of total billed charges,76% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,117.67,32.96,,,percent of total billed charges,32.96% of total billed charges,391.37,105,,,Fee Schedule,pays based on EAPG rates,321.3,90,,,percent of total billed charges,90% of total billed charges,321.3,90,,,percent of total billed charges,90% of total billed charges,372.73,100,,,Fee Schedule,pays based on EAPG rates,316.3,88.6,,,percent of total billed charges,88.6% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,114.24,32,,,percent of total billed charges,32% of total billed charges,285.6,80,,,percent of total billed charges,80% of total billed charges,285.6,80,,,percent of total billed charges,80% of total billed charges,372.73,100,,,Fee Schedule,pays based on EAPG rates,324.87,91,,,percent of total billed charges,91% of total billed charges,116.52,32.64,,,percent of total billed charges,32.64% of total billed charges,114.24,32,,,percent of total billed charges,32% of total billed charges,119.95,33.6,,,percent of total billed charges,33.6% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,114.24,32,,,percent of total billed charges,32% of total billed charges,114.24,32,,,percent of total billed charges,32% of total billed charges,328.44,92,,,percent of total billed charges,92% of total billed charges,114.24,391.37,
POST CARDIOVERSION EKG,5400093,CDM,730,RC,93005,HCPCS,Outpatient,,,207,175.95,,168.08,81.2,,,percent of total billed charges,81.2% of total billed charges,67.56,32.64,,,percent of total billed charges,32.64% of total billed charges,153.18,74,,,percent of total billed charges,74% of total billed charges,153.18,74,,,percent of total billed charges,74% of total billed charges,66.24,32,,,percent of total billed charges,32% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,66.24,32,,,percent of total billed charges,32% of total billed charges,146.97,71,,,percent of total billed charges,71% of total billed charges,146.97,71,,,percent of total billed charges,71% of total billed charges,138.69,67,,,percent of total billed charges,67% of total billed charges,138.69,67,,,percent of total billed charges,67% of total billed charges,146.97,71,,,percent of total billed charges,71% of total billed charges,157.32,76,,,percent of total billed charges,76% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,68.23,32.96,,,percent of total billed charges,32.96% of total billed charges,15.2,105,,,Fee Schedule,pays based on EAPG rates,186.3,90,,,percent of total billed charges,90% of total billed charges,186.3,90,,,percent of total billed charges,90% of total billed charges,14.48,100,,,Fee Schedule,pays based on EAPG rates,183.4,88.6,,,percent of total billed charges,88.6% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,66.24,32,,,percent of total billed charges,32% of total billed charges,165.6,80,,,percent of total billed charges,80% of total billed charges,165.6,80,,,percent of total billed charges,80% of total billed charges,14.48,100,,,Fee Schedule,pays based on EAPG rates,188.37,91,,,percent of total billed charges,91% of total billed charges,67.56,32.64,,,percent of total billed charges,32.64% of total billed charges,66.24,32,,,percent of total billed charges,32% of total billed charges,69.55,33.6,,,percent of total billed charges,33.6% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,66.24,32,,,percent of total billed charges,32% of total billed charges,66.24,32,,,percent of total billed charges,32% of total billed charges,190.44,92,,,percent of total billed charges,92% of total billed charges,14.48,190.44,
EKG,5400053,CDM,730,RC,93005,HCPCS,Outpatient,,,250,212.5,,203,81.2,,,percent of total billed charges,81.2% of total billed charges,81.6,32.64,,,percent of total billed charges,32.64% of total billed charges,185,74,,,percent of total billed charges,74% of total billed charges,185,74,,,percent of total billed charges,74% of total billed charges,80,32,,,percent of total billed charges,32% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,80,32,,,percent of total billed charges,32% of total billed charges,177.5,71,,,percent of total billed charges,71% of total billed charges,177.5,71,,,percent of total billed charges,71% of total billed charges,167.5,67,,,percent of total billed charges,67% of total billed charges,167.5,67,,,percent of total billed charges,67% of total billed charges,177.5,71,,,percent of total billed charges,71% of total billed charges,190,76,,,percent of total billed charges,76% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,82.4,32.96,,,percent of total billed charges,32.96% of total billed charges,15.2,105,,,Fee Schedule,pays based on EAPG rates,225,90,,,percent of total billed charges,90% of total billed charges,225,90,,,percent of total billed charges,90% of total billed charges,14.48,100,,,Fee Schedule,pays based on EAPG rates,221.5,88.6,,,percent of total billed charges,88.6% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,80,32,,,percent of total billed charges,32% of total billed charges,200,80,,,percent of total billed charges,80% of total billed charges,200,80,,,percent of total billed charges,80% of total billed charges,14.48,100,,,Fee Schedule,pays based on EAPG rates,227.5,91,,,percent of total billed charges,91% of total billed charges,81.6,32.64,,,percent of total billed charges,32.64% of total billed charges,80,32,,,percent of total billed charges,32% of total billed charges,84,33.6,,,percent of total billed charges,33.6% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,80,32,,,percent of total billed charges,32% of total billed charges,80,32,,,percent of total billed charges,32% of total billed charges,230,92,,,percent of total billed charges,92% of total billed charges,14.48,230,
STRESS TEST ONLY CARDIOPUL INCOMPLETE,5400069,CDM,482,RC,93017,HCPCS,Outpatient,,,1265,1075.25,,1027.18,81.2,,,percent of total billed charges,81.2% of total billed charges,412.9,32.64,,,percent of total billed charges,32.64% of total billed charges,936.1,74,,,percent of total billed charges,74% of total billed charges,936.1,74,,,percent of total billed charges,74% of total billed charges,404.8,32,,,percent of total billed charges,32% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,404.8,32,,,percent of total billed charges,32% of total billed charges,898.15,71,,,percent of total billed charges,71% of total billed charges,898.15,71,,,percent of total billed charges,71% of total billed charges,847.55,67,,,percent of total billed charges,67% of total billed charges,847.55,67,,,percent of total billed charges,67% of total billed charges,898.15,71,,,percent of total billed charges,71% of total billed charges,961.4,76,,,percent of total billed charges,76% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,416.94,32.96,,,percent of total billed charges,32.96% of total billed charges,70.21,105,,,Fee Schedule,pays based on EAPG rates,1138.5,90,,,percent of total billed charges,90% of total billed charges,1138.5,90,,,percent of total billed charges,90% of total billed charges,66.87,100,,,Fee Schedule,pays based on EAPG rates,1120.79,88.6,,,percent of total billed charges,88.6% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,404.8,32,,,percent of total billed charges,32% of total billed charges,1012,80,,,percent of total billed charges,80% of total billed charges,1012,80,,,percent of total billed charges,80% of total billed charges,66.87,100,,,Fee Schedule,pays based on EAPG rates,1151.15,91,,,percent of total billed charges,91% of total billed charges,412.9,32.64,,,percent of total billed charges,32.64% of total billed charges,404.8,32,,,percent of total billed charges,32% of total billed charges,425.04,33.6,,,percent of total billed charges,33.6% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,404.8,32,,,percent of total billed charges,32% of total billed charges,404.8,32,,,percent of total billed charges,32% of total billed charges,1163.8,92,,,percent of total billed charges,92% of total billed charges,66.87,1163.8,
STRESS TEST ONLY CARDIOPUL,5400033,CDM,482,RC,93017,HCPCS,Outpatient,,,1320,1122,,1071.84,81.2,,,percent of total billed charges,81.2% of total billed charges,430.85,32.64,,,percent of total billed charges,32.64% of total billed charges,976.8,74,,,percent of total billed charges,74% of total billed charges,976.8,74,,,percent of total billed charges,74% of total billed charges,422.4,32,,,percent of total billed charges,32% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,422.4,32,,,percent of total billed charges,32% of total billed charges,937.2,71,,,percent of total billed charges,71% of total billed charges,937.2,71,,,percent of total billed charges,71% of total billed charges,884.4,67,,,percent of total billed charges,67% of total billed charges,884.4,67,,,percent of total billed charges,67% of total billed charges,937.2,71,,,percent of total billed charges,71% of total billed charges,1003.2,76,,,percent of total billed charges,76% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,435.07,32.96,,,percent of total billed charges,32.96% of total billed charges,70.21,105,,,Fee Schedule,pays based on EAPG rates,1188,90,,,percent of total billed charges,90% of total billed charges,1188,90,,,percent of total billed charges,90% of total billed charges,66.87,100,,,Fee Schedule,pays based on EAPG rates,1169.52,88.6,,,percent of total billed charges,88.6% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,422.4,32,,,percent of total billed charges,32% of total billed charges,1056,80,,,percent of total billed charges,80% of total billed charges,1056,80,,,percent of total billed charges,80% of total billed charges,66.87,100,,,Fee Schedule,pays based on EAPG rates,1201.2,91,,,percent of total billed charges,91% of total billed charges,430.85,32.64,,,percent of total billed charges,32.64% of total billed charges,422.4,32,,,percent of total billed charges,32% of total billed charges,443.52,33.6,,,percent of total billed charges,33.6% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,422.4,32,,,percent of total billed charges,32% of total billed charges,422.4,32,,,percent of total billed charges,32% of total billed charges,1214.4,92,,,percent of total billed charges,92% of total billed charges,66.87,1214.4,
ECG RHYTHM STRIP,5400044,CDM,480,RC,93041,HCPCS,Outpatient,,,117,99.45,,95,81.2,,,percent of total billed charges,81.2% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,88.92,76,,,percent of total billed charges,76% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,38.56,32.96,,,percent of total billed charges,32.96% of total billed charges,15.2,105,,,Fee Schedule,pays based on EAPG rates,105.3,90,,,percent of total billed charges,90% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,14.48,100,,,Fee Schedule,pays based on EAPG rates,103.66,88.6,,,percent of total billed charges,88.6% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,14.48,100,,,Fee Schedule,pays based on EAPG rates,106.47,91,,,percent of total billed charges,91% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,39.31,33.6,,,percent of total billed charges,33.6% of total billed charges,14.91,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,107.64,92,,,percent of total billed charges,92% of total billed charges,14.48,107.64,
HOLTER MONITOR RECORDING,5400003,CDM,731,RC,93225,HCPCS,Outpatient,,,492,418.2,,399.5,81.2,,,percent of total billed charges,81.2% of total billed charges,160.59,32.64,,,percent of total billed charges,32.64% of total billed charges,364.08,74,,,percent of total billed charges,74% of total billed charges,364.08,74,,,percent of total billed charges,74% of total billed charges,157.44,32,,,percent of total billed charges,32% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,157.44,32,,,percent of total billed charges,32% of total billed charges,349.32,71,,,percent of total billed charges,71% of total billed charges,349.32,71,,,percent of total billed charges,71% of total billed charges,329.64,67,,,percent of total billed charges,67% of total billed charges,329.64,67,,,percent of total billed charges,67% of total billed charges,349.32,71,,,percent of total billed charges,71% of total billed charges,373.92,76,,,percent of total billed charges,76% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,162.16,32.96,,,percent of total billed charges,32.96% of total billed charges,56.04,105,,,Fee Schedule,pays based on EAPG rates,442.8,90,,,percent of total billed charges,90% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,53.37,100,,,Fee Schedule,pays based on EAPG rates,435.91,88.6,,,percent of total billed charges,88.6% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,157.44,32,,,percent of total billed charges,32% of total billed charges,393.6,80,,,percent of total billed charges,80% of total billed charges,393.6,80,,,percent of total billed charges,80% of total billed charges,53.37,100,,,Fee Schedule,pays based on EAPG rates,447.72,91,,,percent of total billed charges,91% of total billed charges,160.59,32.64,,,percent of total billed charges,32.64% of total billed charges,157.44,32,,,percent of total billed charges,32% of total billed charges,165.31,33.6,,,percent of total billed charges,33.6% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,157.44,32,,,percent of total billed charges,32% of total billed charges,157.44,32,,,percent of total billed charges,32% of total billed charges,452.64,92,,,percent of total billed charges,92% of total billed charges,53.37,452.64,
HOLTER MONITOR SCAN ANALYSIS W/REPORT,5400058,CDM,731,RC,93226,HCPCS,Outpatient,,,469,398.65,,380.83,81.2,,,percent of total billed charges,81.2% of total billed charges,153.08,32.64,,,percent of total billed charges,32.64% of total billed charges,347.06,74,,,percent of total billed charges,74% of total billed charges,347.06,74,,,percent of total billed charges,74% of total billed charges,150.08,32,,,percent of total billed charges,32% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,150.08,32,,,percent of total billed charges,32% of total billed charges,332.99,71,,,percent of total billed charges,71% of total billed charges,332.99,71,,,percent of total billed charges,71% of total billed charges,314.23,67,,,percent of total billed charges,67% of total billed charges,314.23,67,,,percent of total billed charges,67% of total billed charges,332.99,71,,,percent of total billed charges,71% of total billed charges,356.44,76,,,percent of total billed charges,76% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,154.58,32.96,,,percent of total billed charges,32.96% of total billed charges,56.04,105,,,Fee Schedule,pays based on EAPG rates,422.1,90,,,percent of total billed charges,90% of total billed charges,422.1,90,,,percent of total billed charges,90% of total billed charges,53.37,100,,,Fee Schedule,pays based on EAPG rates,415.53,88.6,,,percent of total billed charges,88.6% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,150.08,32,,,percent of total billed charges,32% of total billed charges,375.2,80,,,percent of total billed charges,80% of total billed charges,375.2,80,,,percent of total billed charges,80% of total billed charges,53.37,100,,,Fee Schedule,pays based on EAPG rates,426.79,91,,,percent of total billed charges,91% of total billed charges,153.08,32.64,,,percent of total billed charges,32.64% of total billed charges,150.08,32,,,percent of total billed charges,32% of total billed charges,157.58,33.6,,,percent of total billed charges,33.6% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,150.08,32,,,percent of total billed charges,32% of total billed charges,150.08,32,,,percent of total billed charges,32% of total billed charges,431.48,92,,,percent of total billed charges,92% of total billed charges,53.37,431.48,
CARDIAC EVENT MTR TELEMETRY,5400095,CDM,732,RC,93229,HCPCS,Outpatient,,,468,397.8,,380.02,81.2,,,percent of total billed charges,81.2% of total billed charges,152.76,32.64,,,percent of total billed charges,32.64% of total billed charges,346.32,74,,,percent of total billed charges,74% of total billed charges,346.32,74,,,percent of total billed charges,74% of total billed charges,149.76,32,,,percent of total billed charges,32% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,149.76,32,,,percent of total billed charges,32% of total billed charges,332.28,71,,,percent of total billed charges,71% of total billed charges,332.28,71,,,percent of total billed charges,71% of total billed charges,313.56,67,,,percent of total billed charges,67% of total billed charges,313.56,67,,,percent of total billed charges,67% of total billed charges,332.28,71,,,percent of total billed charges,71% of total billed charges,355.68,76,,,percent of total billed charges,76% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,154.25,32.96,,,percent of total billed charges,32.96% of total billed charges,56.04,105,,,Fee Schedule,pays based on EAPG rates,421.2,90,,,percent of total billed charges,90% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,53.37,100,,,Fee Schedule,pays based on EAPG rates,414.65,88.6,,,percent of total billed charges,88.6% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,149.76,32,,,percent of total billed charges,32% of total billed charges,374.4,80,,,percent of total billed charges,80% of total billed charges,374.4,80,,,percent of total billed charges,80% of total billed charges,53.37,100,,,Fee Schedule,pays based on EAPG rates,425.88,91,,,percent of total billed charges,91% of total billed charges,152.76,32.64,,,percent of total billed charges,32.64% of total billed charges,149.76,32,,,percent of total billed charges,32% of total billed charges,157.25,33.6,,,percent of total billed charges,33.6% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,149.76,32,,,percent of total billed charges,32% of total billed charges,149.76,32,,,percent of total billed charges,32% of total billed charges,430.56,92,,,percent of total billed charges,92% of total billed charges,53.37,430.56,
CARDIAC EVENT MTR,5400002,CDM,731,RC,93270,HCPCS,Outpatient,,,214,181.9,,173.77,81.2,,,percent of total billed charges,81.2% of total billed charges,69.85,32.64,,,percent of total billed charges,32.64% of total billed charges,158.36,74,,,percent of total billed charges,74% of total billed charges,158.36,74,,,percent of total billed charges,74% of total billed charges,68.48,32,,,percent of total billed charges,32% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,68.48,32,,,percent of total billed charges,32% of total billed charges,151.94,71,,,percent of total billed charges,71% of total billed charges,151.94,71,,,percent of total billed charges,71% of total billed charges,143.38,67,,,percent of total billed charges,67% of total billed charges,143.38,67,,,percent of total billed charges,67% of total billed charges,151.94,71,,,percent of total billed charges,71% of total billed charges,162.64,76,,,percent of total billed charges,76% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,70.53,32.96,,,percent of total billed charges,32.96% of total billed charges,56.04,105,,,Fee Schedule,pays based on EAPG rates,192.6,90,,,percent of total billed charges,90% of total billed charges,192.6,90,,,percent of total billed charges,90% of total billed charges,53.37,100,,,Fee Schedule,pays based on EAPG rates,189.6,88.6,,,percent of total billed charges,88.6% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,68.48,32,,,percent of total billed charges,32% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,171.2,80,,,percent of total billed charges,80% of total billed charges,53.37,100,,,Fee Schedule,pays based on EAPG rates,194.74,91,,,percent of total billed charges,91% of total billed charges,69.85,32.64,,,percent of total billed charges,32.64% of total billed charges,68.48,32,,,percent of total billed charges,32% of total billed charges,71.9,33.6,,,percent of total billed charges,33.6% of total billed charges,54.97,103,,,Fee Schedule,pays based on EAPG rates,68.48,32,,,percent of total billed charges,32% of total billed charges,68.48,32,,,percent of total billed charges,32% of total billed charges,196.88,92,,,percent of total billed charges,92% of total billed charges,53.37,196.88,
PACER CHECK,5400079,CDM,480,RC,93288,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,14.49,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,14.49,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.77,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,14.07,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,14.49,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,14.07,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.49,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,14.07,74.52,
VENT CONTINUOUS INITIAL,5400017,CDM,410,RC,94002,HCPCS,Outpatient,,,938,797.3,,761.66,81.2,,,percent of total billed charges,81.2% of total billed charges,306.16,32.64,,,percent of total billed charges,32.64% of total billed charges,694.12,74,,,percent of total billed charges,74% of total billed charges,694.12,74,,,percent of total billed charges,74% of total billed charges,300.16,32,,,percent of total billed charges,32% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,300.16,32,,,percent of total billed charges,32% of total billed charges,665.98,71,,,percent of total billed charges,71% of total billed charges,665.98,71,,,percent of total billed charges,71% of total billed charges,628.46,67,,,percent of total billed charges,67% of total billed charges,628.46,67,,,percent of total billed charges,67% of total billed charges,665.98,71,,,percent of total billed charges,71% of total billed charges,712.88,76,,,percent of total billed charges,76% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,309.16,32.96,,,percent of total billed charges,32.96% of total billed charges,440.35,105,,,Fee Schedule,pays based on EAPG rates,844.2,90,,,percent of total billed charges,90% of total billed charges,844.2,90,,,percent of total billed charges,90% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,831.07,88.6,,,percent of total billed charges,88.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,300.16,32,,,percent of total billed charges,32% of total billed charges,750.4,80,,,percent of total billed charges,80% of total billed charges,750.4,80,,,percent of total billed charges,80% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,853.58,91,,,percent of total billed charges,91% of total billed charges,306.16,32.64,,,percent of total billed charges,32.64% of total billed charges,300.16,32,,,percent of total billed charges,32% of total billed charges,315.17,33.6,,,percent of total billed charges,33.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,300.16,32,,,percent of total billed charges,32% of total billed charges,300.16,32,,,percent of total billed charges,32% of total billed charges,862.96,92,,,percent of total billed charges,92% of total billed charges,300.16,862.96,
VENT CONTINUOUS SUBSEQUENT,5400018,CDM,480,RC,94003,HCPCS,Outpatient,,,774,657.9,,628.49,81.2,,,percent of total billed charges,81.2% of total billed charges,252.63,32.64,,,percent of total billed charges,32.64% of total billed charges,572.76,74,,,percent of total billed charges,74% of total billed charges,572.76,74,,,percent of total billed charges,74% of total billed charges,247.68,32,,,percent of total billed charges,32% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,247.68,32,,,percent of total billed charges,32% of total billed charges,549.54,71,,,percent of total billed charges,71% of total billed charges,549.54,71,,,percent of total billed charges,71% of total billed charges,518.58,67,,,percent of total billed charges,67% of total billed charges,518.58,67,,,percent of total billed charges,67% of total billed charges,549.54,71,,,percent of total billed charges,71% of total billed charges,588.24,76,,,percent of total billed charges,76% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,255.11,32.96,,,percent of total billed charges,32.96% of total billed charges,440.35,105,,,Fee Schedule,pays based on EAPG rates,696.6,90,,,percent of total billed charges,90% of total billed charges,696.6,90,,,percent of total billed charges,90% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,685.76,88.6,,,percent of total billed charges,88.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,247.68,32,,,percent of total billed charges,32% of total billed charges,619.2,80,,,percent of total billed charges,80% of total billed charges,619.2,80,,,percent of total billed charges,80% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,704.34,91,,,percent of total billed charges,91% of total billed charges,252.63,32.64,,,percent of total billed charges,32.64% of total billed charges,247.68,32,,,percent of total billed charges,32% of total billed charges,260.06,33.6,,,percent of total billed charges,33.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,247.68,32,,,percent of total billed charges,32% of total billed charges,247.68,32,,,percent of total billed charges,32% of total billed charges,712.08,92,,,percent of total billed charges,92% of total billed charges,247.68,712.08,
SPIROMETRY FVC,5400063,CDM,460,RC,94010,HCPCS,Outpatient,,,196,166.6,,159.15,81.2,,,percent of total billed charges,81.2% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,148.96,76,,,percent of total billed charges,76% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,64.6,32.96,,,percent of total billed charges,32.96% of total billed charges,82.77,105,,,Fee Schedule,pays based on EAPG rates,176.4,90,,,percent of total billed charges,90% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,78.83,100,,,Fee Schedule,pays based on EAPG rates,173.66,88.6,,,percent of total billed charges,88.6% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,78.83,100,,,Fee Schedule,pays based on EAPG rates,178.36,91,,,percent of total billed charges,91% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,65.86,33.6,,,percent of total billed charges,33.6% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,180.32,92,,,percent of total billed charges,92% of total billed charges,62.72,180.32,
SPIROMETRY BEFORE/AFTER,5400008,CDM,460,RC,94060,HCPCS,Outpatient,,,331,281.35,,268.77,81.2,,,percent of total billed charges,81.2% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,251.56,76,,,percent of total billed charges,76% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,109.1,32.96,,,percent of total billed charges,32.96% of total billed charges,82.77,105,,,Fee Schedule,pays based on EAPG rates,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,78.83,100,,,Fee Schedule,pays based on EAPG rates,293.27,88.6,,,percent of total billed charges,88.6% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,78.83,100,,,Fee Schedule,pays based on EAPG rates,301.21,91,,,percent of total billed charges,91% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,111.22,33.6,,,percent of total billed charges,33.6% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,304.52,92,,,percent of total billed charges,92% of total billed charges,78.83,304.52,
SPIROMETRY SVC,5400088,CDM,460,RC,94150,HCPCS,Outpatient,,,196,166.6,,159.15,81.2,,,percent of total billed charges,81.2% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,148.96,76,,,percent of total billed charges,76% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,64.6,32.96,,,percent of total billed charges,32.96% of total billed charges,42.03,105,,,Fee Schedule,pays based on EAPG rates,176.4,90,,,percent of total billed charges,90% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,40.03,100,,,Fee Schedule,pays based on EAPG rates,173.66,88.6,,,percent of total billed charges,88.6% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,40.03,100,,,Fee Schedule,pays based on EAPG rates,178.36,91,,,percent of total billed charges,91% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,65.86,33.6,,,percent of total billed charges,33.6% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,180.32,92,,,percent of total billed charges,92% of total billed charges,40.03,180.32,
WALK TEST 6 MIN,5400092,CDM,482,RC,94618,HCPCS,Outpatient,,,374,317.9,,303.69,81.2,,,percent of total billed charges,81.2% of total billed charges,122.07,32.64,,,percent of total billed charges,32.64% of total billed charges,276.76,74,,,percent of total billed charges,74% of total billed charges,276.76,74,,,percent of total billed charges,74% of total billed charges,119.68,32,,,percent of total billed charges,32% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,119.68,32,,,percent of total billed charges,32% of total billed charges,265.54,71,,,percent of total billed charges,71% of total billed charges,265.54,71,,,percent of total billed charges,71% of total billed charges,250.58,67,,,percent of total billed charges,67% of total billed charges,250.58,67,,,percent of total billed charges,67% of total billed charges,265.54,71,,,percent of total billed charges,71% of total billed charges,284.24,76,,,percent of total billed charges,76% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,123.27,32.96,,,percent of total billed charges,32.96% of total billed charges,82.77,105,,,Fee Schedule,pays based on EAPG rates,336.6,90,,,percent of total billed charges,90% of total billed charges,336.6,90,,,percent of total billed charges,90% of total billed charges,78.83,100,,,Fee Schedule,pays based on EAPG rates,331.36,88.6,,,percent of total billed charges,88.6% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,119.68,32,,,percent of total billed charges,32% of total billed charges,299.2,80,,,percent of total billed charges,80% of total billed charges,299.2,80,,,percent of total billed charges,80% of total billed charges,78.83,100,,,Fee Schedule,pays based on EAPG rates,340.34,91,,,percent of total billed charges,91% of total billed charges,122.07,32.64,,,percent of total billed charges,32.64% of total billed charges,119.68,32,,,percent of total billed charges,32% of total billed charges,125.66,33.6,,,percent of total billed charges,33.6% of total billed charges,81.19,103,,,Fee Schedule,pays based on EAPG rates,119.68,32,,,percent of total billed charges,32% of total billed charges,119.68,32,,,percent of total billed charges,32% of total billed charges,344.08,92,,,percent of total billed charges,92% of total billed charges,78.83,344.08,
SVN/MDI LVL 1 (1-4 TREATMENTS),5400083,CDM,410,RC,94640,HCPCS,Outpatient,,,100,85,,81.2,81.2,,,percent of total billed charges,81.2% of total billed charges,32.64,32.64,,,percent of total billed charges,32.64% of total billed charges,74,74,,,percent of total billed charges,74% of total billed charges,74,74,,,percent of total billed charges,74% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,32,32,,,percent of total billed charges,32% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,67,67,,,percent of total billed charges,67% of total billed charges,67,67,,,percent of total billed charges,67% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,76,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,32.96,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,88.6,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,32,32,,,percent of total billed charges,32% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,91,91,,,percent of total billed charges,91% of total billed charges,32.64,32.64,,,percent of total billed charges,32.64% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,33.6,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,32,32,,,percent of total billed charges,32% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,92,92,,,percent of total billed charges,92% of total billed charges,32,92,
SVN/MDI LVL 3 (>8 TREATMENTS),5400094,CDM,410,RC,94640,HCPCS,Outpatient,,,1052,894.2,,854.22,81.2,,,percent of total billed charges,81.2% of total billed charges,343.37,32.64,,,percent of total billed charges,32.64% of total billed charges,778.48,74,,,percent of total billed charges,74% of total billed charges,778.48,74,,,percent of total billed charges,74% of total billed charges,336.64,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,336.64,32,,,percent of total billed charges,32% of total billed charges,746.92,71,,,percent of total billed charges,71% of total billed charges,746.92,71,,,percent of total billed charges,71% of total billed charges,704.84,67,,,percent of total billed charges,67% of total billed charges,704.84,67,,,percent of total billed charges,67% of total billed charges,746.92,71,,,percent of total billed charges,71% of total billed charges,799.52,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,346.74,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,946.8,90,,,percent of total billed charges,90% of total billed charges,946.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,932.07,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,336.64,32,,,percent of total billed charges,32% of total billed charges,841.6,80,,,percent of total billed charges,80% of total billed charges,841.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,957.32,91,,,percent of total billed charges,91% of total billed charges,343.37,32.64,,,percent of total billed charges,32.64% of total billed charges,336.64,32,,,percent of total billed charges,32% of total billed charges,353.47,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,336.64,32,,,percent of total billed charges,32% of total billed charges,336.64,32,,,percent of total billed charges,32% of total billed charges,967.84,92,,,percent of total billed charges,92% of total billed charges,336.64,967.84,
NONINVASIVE VENT CPAP SUBSEQUE,5400035,CDM,410,RC,94660,HCPCS,Outpatient,,,108,91.8,,87.7,81.2,,,percent of total billed charges,81.2% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,82.08,76,,,percent of total billed charges,76% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,35.6,32.96,,,percent of total billed charges,32.96% of total billed charges,440.35,105,,,Fee Schedule,pays based on EAPG rates,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,95.69,88.6,,,percent of total billed charges,88.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,98.28,91,,,percent of total billed charges,91% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,36.29,33.6,,,percent of total billed charges,33.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,99.36,92,,,percent of total billed charges,92% of total billed charges,34.56,440.35,
VAPOTHERM SUBSEQUENT,5400081,CDM,410,RC,94660,HCPCS,Outpatient,,,108,91.8,,87.7,81.2,,,percent of total billed charges,81.2% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,82.08,76,,,percent of total billed charges,76% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,35.6,32.96,,,percent of total billed charges,32.96% of total billed charges,440.35,105,,,Fee Schedule,pays based on EAPG rates,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,95.69,88.6,,,percent of total billed charges,88.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,98.28,91,,,percent of total billed charges,91% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,36.29,33.6,,,percent of total billed charges,33.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,99.36,92,,,percent of total billed charges,92% of total billed charges,34.56,440.35,
NONINVASIVE VENT CPAP INITIAL,5400010,CDM,410,RC,94660,HCPCS,Outpatient,,,531,451.35,,431.17,81.2,,,percent of total billed charges,81.2% of total billed charges,173.32,32.64,,,percent of total billed charges,32.64% of total billed charges,392.94,74,,,percent of total billed charges,74% of total billed charges,392.94,74,,,percent of total billed charges,74% of total billed charges,169.92,32,,,percent of total billed charges,32% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,169.92,32,,,percent of total billed charges,32% of total billed charges,377.01,71,,,percent of total billed charges,71% of total billed charges,377.01,71,,,percent of total billed charges,71% of total billed charges,355.77,67,,,percent of total billed charges,67% of total billed charges,355.77,67,,,percent of total billed charges,67% of total billed charges,377.01,71,,,percent of total billed charges,71% of total billed charges,403.56,76,,,percent of total billed charges,76% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,175.02,32.96,,,percent of total billed charges,32.96% of total billed charges,440.35,105,,,Fee Schedule,pays based on EAPG rates,477.9,90,,,percent of total billed charges,90% of total billed charges,477.9,90,,,percent of total billed charges,90% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,470.47,88.6,,,percent of total billed charges,88.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,169.92,32,,,percent of total billed charges,32% of total billed charges,424.8,80,,,percent of total billed charges,80% of total billed charges,424.8,80,,,percent of total billed charges,80% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,483.21,91,,,percent of total billed charges,91% of total billed charges,173.32,32.64,,,percent of total billed charges,32.64% of total billed charges,169.92,32,,,percent of total billed charges,32% of total billed charges,178.42,33.6,,,percent of total billed charges,33.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,169.92,32,,,percent of total billed charges,32% of total billed charges,169.92,32,,,percent of total billed charges,32% of total billed charges,488.52,92,,,percent of total billed charges,92% of total billed charges,169.92,488.52,
VAPOTHERM INITIAL,5400080,CDM,410,RC,94660,HCPCS,Outpatient,,,531,451.35,,431.17,81.2,,,percent of total billed charges,81.2% of total billed charges,173.32,32.64,,,percent of total billed charges,32.64% of total billed charges,392.94,74,,,percent of total billed charges,74% of total billed charges,392.94,74,,,percent of total billed charges,74% of total billed charges,169.92,32,,,percent of total billed charges,32% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,169.92,32,,,percent of total billed charges,32% of total billed charges,377.01,71,,,percent of total billed charges,71% of total billed charges,377.01,71,,,percent of total billed charges,71% of total billed charges,355.77,67,,,percent of total billed charges,67% of total billed charges,355.77,67,,,percent of total billed charges,67% of total billed charges,377.01,71,,,percent of total billed charges,71% of total billed charges,403.56,76,,,percent of total billed charges,76% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,175.02,32.96,,,percent of total billed charges,32.96% of total billed charges,440.35,105,,,Fee Schedule,pays based on EAPG rates,477.9,90,,,percent of total billed charges,90% of total billed charges,477.9,90,,,percent of total billed charges,90% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,470.47,88.6,,,percent of total billed charges,88.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,169.92,32,,,percent of total billed charges,32% of total billed charges,424.8,80,,,percent of total billed charges,80% of total billed charges,424.8,80,,,percent of total billed charges,80% of total billed charges,419.38,100,,,Fee Schedule,pays based on EAPG rates,483.21,91,,,percent of total billed charges,91% of total billed charges,173.32,32.64,,,percent of total billed charges,32.64% of total billed charges,169.92,32,,,percent of total billed charges,32% of total billed charges,178.42,33.6,,,percent of total billed charges,33.6% of total billed charges,431.96,103,,,Fee Schedule,pays based on EAPG rates,169.92,32,,,percent of total billed charges,32% of total billed charges,169.92,32,,,percent of total billed charges,32% of total billed charges,488.52,92,,,percent of total billed charges,92% of total billed charges,169.92,488.52,
SVN/MDI INITIAL,5400076,CDM,410,RC,94664,HCPCS,Outpatient,,,142,120.7,,115.3,81.2,,,percent of total billed charges,81.2% of total billed charges,46.35,32.64,,,percent of total billed charges,32.64% of total billed charges,105.08,74,,,percent of total billed charges,74% of total billed charges,105.08,74,,,percent of total billed charges,74% of total billed charges,45.44,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,45.44,32,,,percent of total billed charges,32% of total billed charges,100.82,71,,,percent of total billed charges,71% of total billed charges,100.82,71,,,percent of total billed charges,71% of total billed charges,95.14,67,,,percent of total billed charges,67% of total billed charges,95.14,67,,,percent of total billed charges,67% of total billed charges,100.82,71,,,percent of total billed charges,71% of total billed charges,107.92,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,46.8,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,127.8,90,,,percent of total billed charges,90% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,125.81,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,45.44,32,,,percent of total billed charges,32% of total billed charges,113.6,80,,,percent of total billed charges,80% of total billed charges,113.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,129.22,91,,,percent of total billed charges,91% of total billed charges,46.35,32.64,,,percent of total billed charges,32.64% of total billed charges,45.44,32,,,percent of total billed charges,32% of total billed charges,47.71,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,45.44,32,,,percent of total billed charges,32% of total billed charges,45.44,32,,,percent of total billed charges,32% of total billed charges,130.64,92,,,percent of total billed charges,92% of total billed charges,45.44,130.64,
CHEST PHYSIOTHERAPY INITIAL (NON PEP),5400006,CDM,410,RC,94667,HCPCS,Outpatient,,,112,95.2,,90.94,81.2,,,percent of total billed charges,81.2% of total billed charges,36.56,32.64,,,percent of total billed charges,32.64% of total billed charges,82.88,74,,,percent of total billed charges,74% of total billed charges,82.88,74,,,percent of total billed charges,74% of total billed charges,35.84,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,35.84,32,,,percent of total billed charges,32% of total billed charges,79.52,71,,,percent of total billed charges,71% of total billed charges,79.52,71,,,percent of total billed charges,71% of total billed charges,75.04,67,,,percent of total billed charges,67% of total billed charges,75.04,67,,,percent of total billed charges,67% of total billed charges,79.52,71,,,percent of total billed charges,71% of total billed charges,85.12,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,36.92,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,100.8,90,,,percent of total billed charges,90% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,99.23,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,35.84,32,,,percent of total billed charges,32% of total billed charges,89.6,80,,,percent of total billed charges,80% of total billed charges,89.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,101.92,91,,,percent of total billed charges,91% of total billed charges,36.56,32.64,,,percent of total billed charges,32.64% of total billed charges,35.84,32,,,percent of total billed charges,32% of total billed charges,37.63,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,35.84,32,,,percent of total billed charges,32% of total billed charges,35.84,32,,,percent of total billed charges,32% of total billed charges,103.04,92,,,percent of total billed charges,92% of total billed charges,35.84,103.04,
CHEST PHYSIOTHERAPY SUBSEQUENT (NON PEP),5400034,CDM,410,RC,94668,HCPCS,Outpatient,,,73,62.05,,59.28,81.2,,,percent of total billed charges,81.2% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,23.36,32,,,percent of total billed charges,32% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,55.48,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,24.06,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,64.68,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.36,32,,,percent of total billed charges,32% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,66.43,91,,,percent of total billed charges,91% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,24.53,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.36,32,,,percent of total billed charges,32% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,67.16,92,,,percent of total billed charges,92% of total billed charges,23.36,67.16,
"PLETHYSMOGRAPHY, TL BDY, TRACE",5400056,CDM,460,RC,94726,HCPCS,Outpatient,,,311,264.35,,252.53,81.2,,,percent of total billed charges,81.2% of total billed charges,101.51,32.64,,,percent of total billed charges,32.64% of total billed charges,230.14,74,,,percent of total billed charges,74% of total billed charges,230.14,74,,,percent of total billed charges,74% of total billed charges,99.52,32,,,percent of total billed charges,32% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,99.52,32,,,percent of total billed charges,32% of total billed charges,220.81,71,,,percent of total billed charges,71% of total billed charges,220.81,71,,,percent of total billed charges,71% of total billed charges,208.37,67,,,percent of total billed charges,67% of total billed charges,208.37,67,,,percent of total billed charges,67% of total billed charges,220.81,71,,,percent of total billed charges,71% of total billed charges,236.36,76,,,percent of total billed charges,76% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,102.51,32.96,,,percent of total billed charges,32.96% of total billed charges,42.03,105,,,Fee Schedule,pays based on EAPG rates,279.9,90,,,percent of total billed charges,90% of total billed charges,279.9,90,,,percent of total billed charges,90% of total billed charges,40.03,100,,,Fee Schedule,pays based on EAPG rates,275.55,88.6,,,percent of total billed charges,88.6% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,99.52,32,,,percent of total billed charges,32% of total billed charges,248.8,80,,,percent of total billed charges,80% of total billed charges,248.8,80,,,percent of total billed charges,80% of total billed charges,40.03,100,,,Fee Schedule,pays based on EAPG rates,283.01,91,,,percent of total billed charges,91% of total billed charges,101.51,32.64,,,percent of total billed charges,32.64% of total billed charges,99.52,32,,,percent of total billed charges,32% of total billed charges,104.5,33.6,,,percent of total billed charges,33.6% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,99.52,32,,,percent of total billed charges,32% of total billed charges,99.52,32,,,percent of total billed charges,32% of total billed charges,286.12,92,,,percent of total billed charges,92% of total billed charges,40.03,286.12,
D L C O,5400027,CDM,460,RC,94729,HCPCS,Outpatient,,,219,186.15,,177.83,81.2,,,percent of total billed charges,81.2% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,166.44,76,,,percent of total billed charges,76% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,72.18,32.96,,,percent of total billed charges,32.96% of total billed charges,42.03,105,,,Fee Schedule,pays based on EAPG rates,197.1,90,,,percent of total billed charges,90% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,40.03,100,,,Fee Schedule,pays based on EAPG rates,194.03,88.6,,,percent of total billed charges,88.6% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,40.03,100,,,Fee Schedule,pays based on EAPG rates,199.29,91,,,percent of total billed charges,91% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,73.58,33.6,,,percent of total billed charges,33.6% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,201.48,92,,,percent of total billed charges,92% of total billed charges,40.03,201.48,
CARBON MONOXIDE TESTING,5400075,CDM,460,RC,94760,HCPCS,Outpatient,,,73,62.05,,59.28,81.2,,,percent of total billed charges,81.2% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,21.3,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,55.48,76,,,percent of total billed charges,76% of total billed charges,21.3,103,,,Fee Schedule,pays based on EAPG rates,24.06,32.96,,,percent of total billed charges,32.96% of total billed charges,21.71,105,,,Fee Schedule,pays based on EAPG rates,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,20.67,100,,,Fee Schedule,pays based on EAPG rates,64.68,88.6,,,percent of total billed charges,88.6% of total billed charges,21.3,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,20.67,100,,,Fee Schedule,pays based on EAPG rates,66.43,91,,,percent of total billed charges,91% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,24.53,33.6,,,percent of total billed charges,33.6% of total billed charges,21.3,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,67.16,92,,,percent of total billed charges,92% of total billed charges,20.67,67.16,
PULSE OXIMETRY EVALUATION,5400046,CDM,460,RC,94761,HCPCS,Outpatient,,,73,62.05,,59.28,81.2,,,percent of total billed charges,81.2% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,21.3,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,55.48,76,,,percent of total billed charges,76% of total billed charges,21.3,103,,,Fee Schedule,pays based on EAPG rates,24.06,32.96,,,percent of total billed charges,32.96% of total billed charges,21.71,105,,,Fee Schedule,pays based on EAPG rates,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,20.67,100,,,Fee Schedule,pays based on EAPG rates,64.68,88.6,,,percent of total billed charges,88.6% of total billed charges,21.3,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,20.67,100,,,Fee Schedule,pays based on EAPG rates,66.43,91,,,percent of total billed charges,91% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,24.53,33.6,,,percent of total billed charges,33.6% of total billed charges,21.3,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,67.16,92,,,percent of total billed charges,92% of total billed charges,20.67,67.16,
OXYGEN CONCENTRATION ANALYSIS,5400019,CDM,270,RC,94799,HCPCS,Outpatient,,,52,44.2,,42.22,81.2,,,percent of total billed charges,81.2% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,39.52,76,,,percent of total billed charges,76% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,17.14,32.96,,,percent of total billed charges,32.96% of total billed charges,42.03,105,,,Fee Schedule,pays based on EAPG rates,46.8,90,,,percent of total billed charges,90% of total billed charges,46.8,90,,,percent of total billed charges,90% of total billed charges,40.03,100,,,Fee Schedule,pays based on EAPG rates,46.07,88.6,,,percent of total billed charges,88.6% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,40.03,100,,,Fee Schedule,pays based on EAPG rates,47.32,91,,,percent of total billed charges,91% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,17.47,33.6,,,percent of total billed charges,33.6% of total billed charges,41.23,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,47.84,92,,,percent of total billed charges,92% of total billed charges,16.64,47.84,
SMOKING CESSATION EDUCATION 3-10 MINS,5400060,CDM,942,RC,99406,HCPCS,Outpatient,,,62,52.7,,50.34,81.2,,,percent of total billed charges,81.2% of total billed charges,20.24,32.64,,,percent of total billed charges,32.64% of total billed charges,45.88,74,,,percent of total billed charges,74% of total billed charges,45.88,74,,,percent of total billed charges,74% of total billed charges,19.84,32,,,percent of total billed charges,32% of total billed charges,26.21,103,,,Fee Schedule,pays based on EAPG rates,19.84,32,,,percent of total billed charges,32% of total billed charges,44.02,71,,,percent of total billed charges,71% of total billed charges,44.02,71,,,percent of total billed charges,71% of total billed charges,41.54,67,,,percent of total billed charges,67% of total billed charges,41.54,67,,,percent of total billed charges,67% of total billed charges,44.02,71,,,percent of total billed charges,71% of total billed charges,47.12,76,,,percent of total billed charges,76% of total billed charges,26.21,103,,,Fee Schedule,pays based on EAPG rates,20.44,32.96,,,percent of total billed charges,32.96% of total billed charges,26.72,105,,,Fee Schedule,pays based on EAPG rates,55.8,90,,,percent of total billed charges,90% of total billed charges,55.8,90,,,percent of total billed charges,90% of total billed charges,25.45,100,,,Fee Schedule,pays based on EAPG rates,54.93,88.6,,,percent of total billed charges,88.6% of total billed charges,26.21,103,,,Fee Schedule,pays based on EAPG rates,19.84,32,,,percent of total billed charges,32% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,25.45,100,,,Fee Schedule,pays based on EAPG rates,56.42,91,,,percent of total billed charges,91% of total billed charges,20.24,32.64,,,percent of total billed charges,32.64% of total billed charges,19.84,32,,,percent of total billed charges,32% of total billed charges,20.83,33.6,,,percent of total billed charges,33.6% of total billed charges,26.21,103,,,Fee Schedule,pays based on EAPG rates,19.84,32,,,percent of total billed charges,32% of total billed charges,19.84,32,,,percent of total billed charges,32% of total billed charges,57.04,92,,,percent of total billed charges,92% of total billed charges,19.84,57.04,
SMOKING CESSATION EDUCATION >10 MINS,5400074,CDM,942,RC,99407,HCPCS,Outpatient,,,62,52.7,,50.34,81.2,,,percent of total billed charges,81.2% of total billed charges,20.24,32.64,,,percent of total billed charges,32.64% of total billed charges,45.88,74,,,percent of total billed charges,74% of total billed charges,45.88,74,,,percent of total billed charges,74% of total billed charges,19.84,32,,,percent of total billed charges,32% of total billed charges,26.21,103,,,Fee Schedule,pays based on EAPG rates,19.84,32,,,percent of total billed charges,32% of total billed charges,44.02,71,,,percent of total billed charges,71% of total billed charges,44.02,71,,,percent of total billed charges,71% of total billed charges,41.54,67,,,percent of total billed charges,67% of total billed charges,41.54,67,,,percent of total billed charges,67% of total billed charges,44.02,71,,,percent of total billed charges,71% of total billed charges,47.12,76,,,percent of total billed charges,76% of total billed charges,26.21,103,,,Fee Schedule,pays based on EAPG rates,20.44,32.96,,,percent of total billed charges,32.96% of total billed charges,26.72,105,,,Fee Schedule,pays based on EAPG rates,55.8,90,,,percent of total billed charges,90% of total billed charges,55.8,90,,,percent of total billed charges,90% of total billed charges,25.45,100,,,Fee Schedule,pays based on EAPG rates,54.93,88.6,,,percent of total billed charges,88.6% of total billed charges,26.21,103,,,Fee Schedule,pays based on EAPG rates,19.84,32,,,percent of total billed charges,32% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,49.6,80,,,percent of total billed charges,80% of total billed charges,25.45,100,,,Fee Schedule,pays based on EAPG rates,56.42,91,,,percent of total billed charges,91% of total billed charges,20.24,32.64,,,percent of total billed charges,32.64% of total billed charges,19.84,32,,,percent of total billed charges,32% of total billed charges,20.83,33.6,,,percent of total billed charges,33.6% of total billed charges,26.21,103,,,Fee Schedule,pays based on EAPG rates,19.84,32,,,percent of total billed charges,32% of total billed charges,19.84,32,,,percent of total billed charges,32% of total billed charges,57.04,92,,,percent of total billed charges,92% of total billed charges,19.84,57.04,
ATTENDANCE & STABILIZATION NB,5400040,CDM,410,RC,99464,HCPCS,Outpatient,,,267,226.95,,216.8,81.2,,,percent of total billed charges,81.2% of total billed charges,87.15,32.64,,,percent of total billed charges,32.64% of total billed charges,197.58,74,,,percent of total billed charges,74% of total billed charges,197.58,74,,,percent of total billed charges,74% of total billed charges,85.44,32,,,percent of total billed charges,32% of total billed charges,257.37,103,,,Fee Schedule,pays based on EAPG rates,85.44,32,,,percent of total billed charges,32% of total billed charges,189.57,71,,,percent of total billed charges,71% of total billed charges,189.57,71,,,percent of total billed charges,71% of total billed charges,178.89,67,,,percent of total billed charges,67% of total billed charges,178.89,67,,,percent of total billed charges,67% of total billed charges,189.57,71,,,percent of total billed charges,71% of total billed charges,202.92,76,,,percent of total billed charges,76% of total billed charges,257.37,103,,,Fee Schedule,pays based on EAPG rates,88,32.96,,,percent of total billed charges,32.96% of total billed charges,262.37,105,,,Fee Schedule,pays based on EAPG rates,240.3,90,,,percent of total billed charges,90% of total billed charges,240.3,90,,,percent of total billed charges,90% of total billed charges,249.87,100,,,Fee Schedule,pays based on EAPG rates,236.56,88.6,,,percent of total billed charges,88.6% of total billed charges,257.37,103,,,Fee Schedule,pays based on EAPG rates,85.44,32,,,percent of total billed charges,32% of total billed charges,213.6,80,,,percent of total billed charges,80% of total billed charges,213.6,80,,,percent of total billed charges,80% of total billed charges,249.87,100,,,Fee Schedule,pays based on EAPG rates,242.97,91,,,percent of total billed charges,91% of total billed charges,87.15,32.64,,,percent of total billed charges,32.64% of total billed charges,85.44,32,,,percent of total billed charges,32% of total billed charges,89.71,33.6,,,percent of total billed charges,33.6% of total billed charges,257.37,103,,,Fee Schedule,pays based on EAPG rates,85.44,32,,,percent of total billed charges,32% of total billed charges,85.44,32,,,percent of total billed charges,32% of total billed charges,245.64,92,,,percent of total billed charges,92% of total billed charges,85.44,262.37,
NEWBORN RESUSCITATION,5400039,CDM,410,RC,99465,HCPCS,Outpatient,,,357,303.45,,289.88,81.2,,,percent of total billed charges,81.2% of total billed charges,116.52,32.64,,,percent of total billed charges,32.64% of total billed charges,264.18,74,,,percent of total billed charges,74% of total billed charges,264.18,74,,,percent of total billed charges,74% of total billed charges,114.24,32,,,percent of total billed charges,32% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,114.24,32,,,percent of total billed charges,32% of total billed charges,253.47,71,,,percent of total billed charges,71% of total billed charges,253.47,71,,,percent of total billed charges,71% of total billed charges,239.19,67,,,percent of total billed charges,67% of total billed charges,239.19,67,,,percent of total billed charges,67% of total billed charges,253.47,71,,,percent of total billed charges,71% of total billed charges,271.32,76,,,percent of total billed charges,76% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,117.67,32.96,,,percent of total billed charges,32.96% of total billed charges,391.37,105,,,Fee Schedule,pays based on EAPG rates,321.3,90,,,percent of total billed charges,90% of total billed charges,321.3,90,,,percent of total billed charges,90% of total billed charges,372.73,100,,,Fee Schedule,pays based on EAPG rates,316.3,88.6,,,percent of total billed charges,88.6% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,114.24,32,,,percent of total billed charges,32% of total billed charges,285.6,80,,,percent of total billed charges,80% of total billed charges,285.6,80,,,percent of total billed charges,80% of total billed charges,372.73,100,,,Fee Schedule,pays based on EAPG rates,324.87,91,,,percent of total billed charges,91% of total billed charges,116.52,32.64,,,percent of total billed charges,32.64% of total billed charges,114.24,32,,,percent of total billed charges,32% of total billed charges,119.95,33.6,,,percent of total billed charges,33.6% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,114.24,32,,,percent of total billed charges,32% of total billed charges,114.24,32,,,percent of total billed charges,32% of total billed charges,328.44,92,,,percent of total billed charges,92% of total billed charges,114.24,391.37,
OXYGEN PER HOUR PER DAY,5400012,CDM,270,RC,,,Outpatient,,,156,132.6,,126.67,81.2,,,percent of total billed charges,81.2% of total billed charges,50.92,32.64,,,percent of total billed charges,32.64% of total billed charges,115.44,74,,,percent of total billed charges,74% of total billed charges,115.44,74,,,percent of total billed charges,74% of total billed charges,49.92,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,49.92,32,,,percent of total billed charges,32% of total billed charges,110.76,71,,,percent of total billed charges,71% of total billed charges,110.76,71,,,percent of total billed charges,71% of total billed charges,104.52,67,,,percent of total billed charges,67% of total billed charges,104.52,67,,,percent of total billed charges,67% of total billed charges,110.76,71,,,percent of total billed charges,71% of total billed charges,118.56,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,51.42,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,140.4,90,,,percent of total billed charges,90% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,138.22,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,49.92,32,,,percent of total billed charges,32% of total billed charges,124.8,80,,,percent of total billed charges,80% of total billed charges,124.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,141.96,91,,,percent of total billed charges,91% of total billed charges,50.92,32.64,,,percent of total billed charges,32.64% of total billed charges,49.92,32,,,percent of total billed charges,32% of total billed charges,52.42,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,49.92,32,,,percent of total billed charges,32% of total billed charges,49.92,32,,,percent of total billed charges,32% of total billed charges,143.52,92,,,percent of total billed charges,92% of total billed charges,49.92,143.52,
CT GUIDE MUSCLE BX,4200108,CDM,360,RC,20206,HCPCS,Outpatient,,,6059,5150.15,,4919.91,81.2,,,percent of total billed charges,81.2% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,1938.88,32,,,percent of total billed charges,32% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,4604.84,100,,,Fee Schedule,pays based on grouper fee Schedule,244.09,103,,,Fee Schedule,pays based on EAPG rates,1997.05,32.96,,,percent of total billed charges,32.96% of total billed charges,248.83,105,,,Fee Schedule,pays based on EAPG rates,5453.1,90,,,percent of total billed charges,90% of total billed charges,5453.1,90,,,percent of total billed charges,90% of total billed charges,236.98,100,,,Fee Schedule,pays based on EAPG rates,5368.27,88.6,,,percent of total billed charges,88.6% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,236.98,100,,,Fee Schedule,pays based on EAPG rates,5513.69,91,,,percent of total billed charges,91% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,2035.82,33.6,,,percent of total billed charges,33.6% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,5574.28,92,,,percent of total billed charges,92% of total billed charges,236.98,5574.28,
CT GUIDE SCAPULA BX,4200246,CDM,360,RC,20220,HCPCS,Outpatient,,,6059,5150.15,,4919.91,81.2,,,percent of total billed charges,81.2% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,1938.88,32,,,percent of total billed charges,32% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,4604.84,100,,,Fee Schedule,pays based on grouper fee Schedule,244.09,103,,,Fee Schedule,pays based on EAPG rates,1997.05,32.96,,,percent of total billed charges,32.96% of total billed charges,248.83,105,,,Fee Schedule,pays based on EAPG rates,5453.1,90,,,percent of total billed charges,90% of total billed charges,5453.1,90,,,percent of total billed charges,90% of total billed charges,236.98,100,,,Fee Schedule,pays based on EAPG rates,5368.27,88.6,,,percent of total billed charges,88.6% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,236.98,100,,,Fee Schedule,pays based on EAPG rates,5513.69,91,,,percent of total billed charges,91% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,2035.82,33.6,,,percent of total billed charges,33.6% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,5574.28,92,,,percent of total billed charges,92% of total billed charges,236.98,5574.28,
CT GUIDE LUNG BX,4200247,CDM,360,RC,32408,HCPCS,Outpatient,,,6059,5150.15,,4919.91,81.2,,,percent of total billed charges,81.2% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,4483.66,74,,,percent of total billed charges,74% of total billed charges,4483.66,74,,,percent of total billed charges,74% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,1938.88,32,,,percent of total billed charges,32% of total billed charges,4301.89,71,,,percent of total billed charges,71% of total billed charges,4301.89,71,,,percent of total billed charges,71% of total billed charges,4059.53,67,,,percent of total billed charges,67% of total billed charges,4059.53,67,,,percent of total billed charges,67% of total billed charges,4301.89,71,,,percent of total billed charges,71% of total billed charges,4604.84,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,1997.05,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,5453.1,90,,,percent of total billed charges,90% of total billed charges,5453.1,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,5368.27,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,1938.88,32,,,percent of total billed charges,32% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,5513.69,91,,,percent of total billed charges,91% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,2035.82,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,1938.88,32,,,percent of total billed charges,32% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,5574.28,92,,,percent of total billed charges,92% of total billed charges,1938.88,5574.28,
CT BONE MARROW BX/ASPIRATION,4200250,CDM,761,RC,38222,HCPCS,Outpatient,,,193,164.05,,156.72,81.2,,,percent of total billed charges,81.2% of total billed charges,63,32.64,,,percent of total billed charges,32.64% of total billed charges,142.82,74,,,percent of total billed charges,74% of total billed charges,142.82,74,,,percent of total billed charges,74% of total billed charges,61.76,32,,,percent of total billed charges,32% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,61.76,32,,,percent of total billed charges,32% of total billed charges,137.03,71,,,percent of total billed charges,71% of total billed charges,137.03,71,,,percent of total billed charges,71% of total billed charges,129.31,67,,,percent of total billed charges,67% of total billed charges,129.31,67,,,percent of total billed charges,67% of total billed charges,137.03,71,,,percent of total billed charges,71% of total billed charges,146.68,76,,,percent of total billed charges,76% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,63.61,32.96,,,percent of total billed charges,32.96% of total billed charges,855.18,105,,,Fee Schedule,pays based on EAPG rates,173.7,90,,,percent of total billed charges,90% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,814.46,100,,,Fee Schedule,pays based on EAPG rates,171,88.6,,,percent of total billed charges,88.6% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,61.76,32,,,percent of total billed charges,32% of total billed charges,154.4,80,,,percent of total billed charges,80% of total billed charges,154.4,80,,,percent of total billed charges,80% of total billed charges,814.46,100,,,Fee Schedule,pays based on EAPG rates,175.63,91,,,percent of total billed charges,91% of total billed charges,63,32.64,,,percent of total billed charges,32.64% of total billed charges,61.76,32,,,percent of total billed charges,32% of total billed charges,64.85,33.6,,,percent of total billed charges,33.6% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,61.76,32,,,percent of total billed charges,32% of total billed charges,61.76,32,,,percent of total billed charges,32% of total billed charges,177.56,92,,,percent of total billed charges,92% of total billed charges,61.76,855.18,
CT GUIDE LIVER BX,4200248,CDM,360,RC,47000,HCPCS,Outpatient,,,6059,5150.15,,4919.91,81.2,,,percent of total billed charges,81.2% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,1938.88,32,,,percent of total billed charges,32% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,4604.84,100,,,Fee Schedule,pays based on grouper fee Schedule,293.06,103,,,Fee Schedule,pays based on EAPG rates,1997.05,32.96,,,percent of total billed charges,32.96% of total billed charges,298.75,105,,,Fee Schedule,pays based on EAPG rates,5453.1,90,,,percent of total billed charges,90% of total billed charges,5453.1,90,,,percent of total billed charges,90% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,5368.27,88.6,,,percent of total billed charges,88.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,5513.69,91,,,percent of total billed charges,91% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,2035.82,33.6,,,percent of total billed charges,33.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,5574.28,92,,,percent of total billed charges,92% of total billed charges,284.53,5574.28,
CT GUIDE ADRENAL BX,4200249,CDM,360,RC,49180,HCPCS,Outpatient,,,6059,5150.15,,4919.91,81.2,,,percent of total billed charges,81.2% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,1938.88,32,,,percent of total billed charges,32% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,4604.84,100,,,Fee Schedule,pays based on grouper fee Schedule,293.06,103,,,Fee Schedule,pays based on EAPG rates,1997.05,32.96,,,percent of total billed charges,32.96% of total billed charges,298.75,105,,,Fee Schedule,pays based on EAPG rates,5453.1,90,,,percent of total billed charges,90% of total billed charges,5453.1,90,,,percent of total billed charges,90% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,5368.27,88.6,,,percent of total billed charges,88.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,4847.2,80,,,percent of total billed charges,80% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,5513.69,91,,,percent of total billed charges,91% of total billed charges,1977.66,32.64,,,percent of total billed charges,32.64% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,2035.82,33.6,,,percent of total billed charges,33.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1938.88,32,,,percent of total billed charges,32% of total billed charges,1938.88,32,,,percent of total billed charges,32% of total billed charges,5574.28,92,,,percent of total billed charges,92% of total billed charges,284.53,5574.28,
CT HEAD OR BRAIN WO,4200007,CDM,350,RC,70450,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1297.2,
CT HEAD OR BRAIN W,4200006,CDM,350,RC,70460,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HEAD OR BRAIN WWO,4200008,CDM,350,RC,70470,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT ORBIT SELLA POS.FOSSA WO,4200016,CDM,350,RC,70480,HCPCS,Outpatient,,,1380,1173,,1120.56,81.2,,,percent of total billed charges,81.2% of total billed charges,450.43,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,441.6,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,441.6,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1048.8,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,454.85,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1242,90,,,percent of total billed charges,90% of total billed charges,1242,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1222.68,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,441.6,32,,,percent of total billed charges,32% of total billed charges,1104,80,,,percent of total billed charges,80% of total billed charges,1104,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1255.8,91,,,percent of total billed charges,91% of total billed charges,450.43,32.64,,,percent of total billed charges,32.64% of total billed charges,441.6,32,,,percent of total billed charges,32% of total billed charges,463.68,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,441.6,32,,,percent of total billed charges,32% of total billed charges,441.6,32,,,percent of total billed charges,32% of total billed charges,1269.6,92,,,percent of total billed charges,92% of total billed charges,113.15,1269.6,
CT OUT/MID/IN EAR WO,4200018,CDM,350,RC,70480,HCPCS,Outpatient,,,1380,1173,,1120.56,81.2,,,percent of total billed charges,81.2% of total billed charges,450.43,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,441.6,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,441.6,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1048.8,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,454.85,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1242,90,,,percent of total billed charges,90% of total billed charges,1242,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1222.68,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,441.6,32,,,percent of total billed charges,32% of total billed charges,1104,80,,,percent of total billed charges,80% of total billed charges,1104,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1255.8,91,,,percent of total billed charges,91% of total billed charges,450.43,32.64,,,percent of total billed charges,32.64% of total billed charges,441.6,32,,,percent of total billed charges,32% of total billed charges,463.68,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,441.6,32,,,percent of total billed charges,32% of total billed charges,441.6,32,,,percent of total billed charges,32% of total billed charges,1269.6,92,,,percent of total billed charges,92% of total billed charges,113.15,1269.6,
CT TEMPORAL BONES WO,4200227,CDM,350,RC,70480,HCPCS,Outpatient,,,1380,1173,,1120.56,81.2,,,percent of total billed charges,81.2% of total billed charges,450.43,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,441.6,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,441.6,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1048.8,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,454.85,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1242,90,,,percent of total billed charges,90% of total billed charges,1242,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1222.68,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,441.6,32,,,percent of total billed charges,32% of total billed charges,1104,80,,,percent of total billed charges,80% of total billed charges,1104,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1255.8,91,,,percent of total billed charges,91% of total billed charges,450.43,32.64,,,percent of total billed charges,32.64% of total billed charges,441.6,32,,,percent of total billed charges,32% of total billed charges,463.68,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,441.6,32,,,percent of total billed charges,32% of total billed charges,441.6,32,,,percent of total billed charges,32% of total billed charges,1269.6,92,,,percent of total billed charges,92% of total billed charges,113.15,1269.6,
CT ORBIT SELLA W,4200015,CDM,350,RC,70481,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,242.56,1395.64,
CT TEMPORAL BONES W,4200226,CDM,350,RC,70481,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,242.56,1395.64,
CT ORBIT SELLA POS.FOSSA WWO,4200017,CDM,350,RC,70482,HCPCS,Outpatient,,,1689,1435.65,,1371.47,81.2,,,percent of total billed charges,81.2% of total billed charges,551.29,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,540.48,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,540.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1283.64,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,556.69,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1520.1,90,,,percent of total billed charges,90% of total billed charges,1520.1,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1496.45,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,540.48,32,,,percent of total billed charges,32% of total billed charges,1351.2,80,,,percent of total billed charges,80% of total billed charges,1351.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1536.99,91,,,percent of total billed charges,91% of total billed charges,551.29,32.64,,,percent of total billed charges,32.64% of total billed charges,540.48,32,,,percent of total billed charges,32% of total billed charges,567.5,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,540.48,32,,,percent of total billed charges,32% of total billed charges,540.48,32,,,percent of total billed charges,32% of total billed charges,1553.88,92,,,percent of total billed charges,92% of total billed charges,242.56,1553.88,
CT TEMPORAL BONES WWO,4200228,CDM,350,RC,70482,HCPCS,Outpatient,,,1689,1435.65,,1371.47,81.2,,,percent of total billed charges,81.2% of total billed charges,551.29,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,540.48,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,540.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1283.64,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,556.69,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1520.1,90,,,percent of total billed charges,90% of total billed charges,1520.1,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1496.45,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,540.48,32,,,percent of total billed charges,32% of total billed charges,1351.2,80,,,percent of total billed charges,80% of total billed charges,1351.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1536.99,91,,,percent of total billed charges,91% of total billed charges,551.29,32.64,,,percent of total billed charges,32.64% of total billed charges,540.48,32,,,percent of total billed charges,32% of total billed charges,567.5,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,540.48,32,,,percent of total billed charges,32% of total billed charges,540.48,32,,,percent of total billed charges,32% of total billed charges,1553.88,92,,,percent of total billed charges,92% of total billed charges,242.56,1553.88,
CT FACIAL BONES WO,4200232,CDM,350,RC,70486,HCPCS,Outpatient,,,1814,1541.9,,1472.97,81.2,,,percent of total billed charges,81.2% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,580.48,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1378.64,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,597.89,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1607.2,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1650.74,91,,,percent of total billed charges,91% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,609.5,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,1668.88,92,,,percent of total billed charges,92% of total billed charges,113.15,1668.88,
CT SINUSES WO,4200229,CDM,350,RC,70486,HCPCS,Outpatient,,,1814,1541.9,,1472.97,81.2,,,percent of total billed charges,81.2% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,580.48,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1378.64,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,597.89,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1607.2,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1650.74,91,,,percent of total billed charges,91% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,609.5,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,1668.88,92,,,percent of total billed charges,92% of total billed charges,113.15,1668.88,
CT FACIAL BONES W,4200233,CDM,350,RC,70487,HCPCS,Outpatient,,,1814,1541.9,,1472.97,81.2,,,percent of total billed charges,81.2% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,580.48,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1378.64,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,597.89,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1607.2,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1650.74,91,,,percent of total billed charges,91% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,609.5,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,1668.88,92,,,percent of total billed charges,92% of total billed charges,242.56,1668.88,
CT MAXILLOFACIAL W,4200013,CDM,350,RC,70487,HCPCS,Outpatient,,,1814,1541.9,,1472.97,81.2,,,percent of total billed charges,81.2% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,580.48,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1378.64,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,597.89,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1607.2,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1650.74,91,,,percent of total billed charges,91% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,609.5,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,1668.88,92,,,percent of total billed charges,92% of total billed charges,242.56,1668.88,
CT SINUSES W,4200230,CDM,350,RC,70487,HCPCS,Outpatient,,,1814,1541.9,,1472.97,81.2,,,percent of total billed charges,81.2% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,580.48,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1378.64,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,597.89,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1607.2,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1650.74,91,,,percent of total billed charges,91% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,609.5,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,1668.88,92,,,percent of total billed charges,92% of total billed charges,242.56,1668.88,
CT FACIAL BONES WWO,4200234,CDM,350,RC,70488,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT MAXILLOFACIAL WWO,4200231,CDM,350,RC,70488,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT SINUSES WWO,4200014,CDM,350,RC,70488,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT SOFT TISSUE NECK WO,4200023,CDM,350,RC,70490,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT SOFT TISSUE NECK W,4200022,CDM,350,RC,70491,HCPCS,Outpatient,,,1814,1541.9,,1472.97,81.2,,,percent of total billed charges,81.2% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,580.48,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1378.64,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,597.89,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1607.2,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1650.74,91,,,percent of total billed charges,91% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,609.5,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,1668.88,92,,,percent of total billed charges,92% of total billed charges,242.56,1668.88,
CT SOFT TISSUE NECK WWO,4200024,CDM,350,RC,70492,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CTA HEAD/BRAIN WWO,4200058,CDM,350,RC,70496,HCPCS,Outpatient,,,1852,1574.2,,1503.82,81.2,,,percent of total billed charges,81.2% of total billed charges,604.49,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,592.64,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,592.64,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1407.52,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,610.42,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,1666.8,90,,,percent of total billed charges,90% of total billed charges,1666.8,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,1640.87,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,592.64,32,,,percent of total billed charges,32% of total billed charges,1481.6,80,,,percent of total billed charges,80% of total billed charges,1481.6,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,1685.32,91,,,percent of total billed charges,91% of total billed charges,604.49,32.64,,,percent of total billed charges,32.64% of total billed charges,592.64,32,,,percent of total billed charges,32% of total billed charges,622.27,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,592.64,32,,,percent of total billed charges,32% of total billed charges,592.64,32,,,percent of total billed charges,32% of total billed charges,1703.84,92,,,percent of total billed charges,92% of total billed charges,279.34,1703.84,
CTA CAROTIDS W,4200060,CDM,350,RC,70498,HCPCS,Outpatient,,,3442,2925.7,,2794.9,81.2,,,percent of total billed charges,81.2% of total billed charges,1123.47,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,1101.44,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,1101.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,2615.92,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,1134.48,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,3097.8,90,,,percent of total billed charges,90% of total billed charges,3097.8,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,3049.61,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,1101.44,32,,,percent of total billed charges,32% of total billed charges,2753.6,80,,,percent of total billed charges,80% of total billed charges,2753.6,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,3132.22,91,,,percent of total billed charges,91% of total billed charges,1123.47,32.64,,,percent of total billed charges,32.64% of total billed charges,1101.44,32,,,percent of total billed charges,32% of total billed charges,1156.51,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,1101.44,32,,,percent of total billed charges,32% of total billed charges,1101.44,32,,,percent of total billed charges,32% of total billed charges,3166.64,92,,,percent of total billed charges,92% of total billed charges,279.34,3166.64,
CT CHEST HIGH RESOLUTION,4200102,CDM,350,RC,71250,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT CHEST WO,4200029,CDM,350,RC,71250,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT CHEST W,4200028,CDM,350,RC,71260,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,242.56,1395.64,
CT CHEST WWO,4200030,CDM,350,RC,71270,HCPCS,Outpatient,,,1667,1416.95,,1353.6,81.2,,,percent of total billed charges,81.2% of total billed charges,544.11,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,533.44,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,533.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1266.92,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,549.44,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1500.3,90,,,percent of total billed charges,90% of total billed charges,1500.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1476.96,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,533.44,32,,,percent of total billed charges,32% of total billed charges,1333.6,80,,,percent of total billed charges,80% of total billed charges,1333.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1516.97,91,,,percent of total billed charges,91% of total billed charges,544.11,32.64,,,percent of total billed charges,32.64% of total billed charges,533.44,32,,,percent of total billed charges,32% of total billed charges,560.11,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,533.44,32,,,percent of total billed charges,32% of total billed charges,533.44,32,,,percent of total billed charges,32% of total billed charges,1533.64,92,,,percent of total billed charges,92% of total billed charges,242.56,1533.64,
CT LUNG CANCER SCREENING,4200251,CDM,350,RC,71271,HCPCS,Outpatient,,,330,280.5,,267.96,81.2,,,percent of total billed charges,81.2% of total billed charges,107.71,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,105.6,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,105.6,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,250.8,100,,,Case rate,pays based on per visit,,,,,Other,Not Separately reimbursable,108.77,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,297,90,,,percent of total billed charges,90% of total billed charges,297,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,292.38,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,105.6,32,,,percent of total billed charges,32% of total billed charges,264,80,,,percent of total billed charges,80% of total billed charges,264,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,300.3,91,,,percent of total billed charges,91% of total billed charges,107.71,32.64,,,percent of total billed charges,32.64% of total billed charges,105.6,32,,,percent of total billed charges,32% of total billed charges,110.88,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,105.6,32,,,percent of total billed charges,32% of total billed charges,105.6,32,,,percent of total billed charges,32% of total billed charges,303.6,92,,,percent of total billed charges,92% of total billed charges,105.6,1027,
CTA CHEST PE W,4200062,CDM,350,RC,71275,HCPCS,Outpatient,,,1814,1541.9,,1472.97,81.2,,,percent of total billed charges,81.2% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,580.48,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1378.64,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,597.89,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,1607.2,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,1650.74,91,,,percent of total billed charges,91% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,609.5,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,1668.88,92,,,percent of total billed charges,92% of total billed charges,279.34,1668.88,
CTA CHEST WWO,4200245,CDM,350,RC,71275,HCPCS,Outpatient,,,2514,2136.9,,2041.37,81.2,,,percent of total billed charges,81.2% of total billed charges,820.57,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,804.48,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,804.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1910.64,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,828.61,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,2262.6,90,,,percent of total billed charges,90% of total billed charges,2262.6,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2227.4,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,804.48,32,,,percent of total billed charges,32% of total billed charges,2011.2,80,,,percent of total billed charges,80% of total billed charges,2011.2,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2287.74,91,,,percent of total billed charges,91% of total billed charges,820.57,32.64,,,percent of total billed charges,32.64% of total billed charges,804.48,32,,,percent of total billed charges,32% of total billed charges,844.7,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,804.48,32,,,percent of total billed charges,32% of total billed charges,804.48,32,,,percent of total billed charges,32% of total billed charges,2312.88,92,,,percent of total billed charges,92% of total billed charges,279.34,2312.88,
CT CERVICAL SPINE WO,4200025,CDM,350,RC,72125,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT CERVICAL SPINE W,4200048,CDM,350,RC,72126,HCPCS,Outpatient,,,1814,1541.9,,1472.97,81.2,,,percent of total billed charges,81.2% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,580.48,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1378.64,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,597.89,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1607.2,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1650.74,91,,,percent of total billed charges,91% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,609.5,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,1668.88,92,,,percent of total billed charges,92% of total billed charges,242.56,1668.88,
CT CERVICAL SP WWO,4200049,CDM,350,RC,72127,HCPCS,Outpatient,,,2147,1824.95,,1743.36,81.2,,,percent of total billed charges,81.2% of total billed charges,700.78,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,687.04,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,687.04,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1631.72,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,707.65,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1932.3,90,,,percent of total billed charges,90% of total billed charges,1932.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1902.24,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,687.04,32,,,percent of total billed charges,32% of total billed charges,1717.6,80,,,percent of total billed charges,80% of total billed charges,1717.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1953.77,91,,,percent of total billed charges,91% of total billed charges,700.78,32.64,,,percent of total billed charges,32.64% of total billed charges,687.04,32,,,percent of total billed charges,32% of total billed charges,721.39,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,687.04,32,,,percent of total billed charges,32% of total billed charges,687.04,32,,,percent of total billed charges,32% of total billed charges,1975.24,92,,,percent of total billed charges,92% of total billed charges,242.56,1975.24,
CT THORACIC SPINE WO,4200026,CDM,350,RC,72128,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT THORACIC SPINE W,4200046,CDM,350,RC,72129,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT THORACIC SP WWO,4200047,CDM,350,RC,72130,HCPCS,Outpatient,,,2147,1824.95,,1743.36,81.2,,,percent of total billed charges,81.2% of total billed charges,700.78,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,687.04,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,687.04,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1631.72,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,707.65,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1932.3,90,,,percent of total billed charges,90% of total billed charges,1932.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1902.24,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,687.04,32,,,percent of total billed charges,32% of total billed charges,1717.6,80,,,percent of total billed charges,80% of total billed charges,1717.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1953.77,91,,,percent of total billed charges,91% of total billed charges,700.78,32.64,,,percent of total billed charges,32.64% of total billed charges,687.04,32,,,percent of total billed charges,32% of total billed charges,721.39,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,687.04,32,,,percent of total billed charges,32% of total billed charges,687.04,32,,,percent of total billed charges,32% of total billed charges,1975.24,92,,,percent of total billed charges,92% of total billed charges,242.56,1975.24,
CT LUMBAR SPINE WO,4200027,CDM,350,RC,72131,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT LUMBAR SPINE W,4200037,CDM,350,RC,72132,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT LUMBAR SP WWO,4200038,CDM,350,RC,72133,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT PELVIS WO,4200020,CDM,350,RC,72192,HCPCS,Outpatient,,,1370,1164.5,,1112.44,81.2,,,percent of total billed charges,81.2% of total billed charges,447.17,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,438.4,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,438.4,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1041.2,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.55,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1233,90,,,percent of total billed charges,90% of total billed charges,1233,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1213.82,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,438.4,32,,,percent of total billed charges,32% of total billed charges,1096,80,,,percent of total billed charges,80% of total billed charges,1096,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1246.7,91,,,percent of total billed charges,91% of total billed charges,447.17,32.64,,,percent of total billed charges,32.64% of total billed charges,438.4,32,,,percent of total billed charges,32% of total billed charges,460.32,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,438.4,32,,,percent of total billed charges,32% of total billed charges,438.4,32,,,percent of total billed charges,32% of total billed charges,1260.4,92,,,percent of total billed charges,92% of total billed charges,113.15,1260.4,
CT PELVIS W,4200019,CDM,350,RC,72193,HCPCS,Outpatient,,,1591,1352.35,,1291.89,81.2,,,percent of total billed charges,81.2% of total billed charges,519.3,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,509.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,509.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1209.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,524.39,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1431.9,90,,,percent of total billed charges,90% of total billed charges,1431.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1409.63,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,509.12,32,,,percent of total billed charges,32% of total billed charges,1272.8,80,,,percent of total billed charges,80% of total billed charges,1272.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1447.81,91,,,percent of total billed charges,91% of total billed charges,519.3,32.64,,,percent of total billed charges,32.64% of total billed charges,509.12,32,,,percent of total billed charges,32% of total billed charges,534.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,509.12,32,,,percent of total billed charges,32% of total billed charges,509.12,32,,,percent of total billed charges,32% of total billed charges,1463.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1463.72,
CT PELVIS WWO,4200021,CDM,350,RC,72194,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,242.56,1395.64,
CT CLAVICLE LT WO,4200166,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT CLAVICLE RT WO,4200163,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT ELBOW LT WO,4200139,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT ELBOW RT WO,4200136,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT FOREARM LT WO,4200130,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT FOREARM RT WO,4200127,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT HAND LT WO,4200112,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT HAND RT WO,4200109,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT HUMERUS LT WO,4200148,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT HUMERUS RT WO,4200145,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT SHOULDER LT WO,4200157,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT SHOULDER RT WO,4200154,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT WRIST LT WO,4200121,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT WRIST RT WO,4200118,CDM,350,RC,73200,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT CLAVICLE LT W,4200167,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT CLAVICLE RT W,4200164,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT ELBOW LT W,4200140,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT ELBOW RT W,4200137,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FOREARM LT W,4200131,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FOREARM RT W,4200128,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HAND LT W,4200113,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HAND RT W,4200110,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HUMERUS LT W,4200149,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HUMERUS RT W,4200146,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT SHOULDER LT W,4200158,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT SHOULDER RT W,4200155,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT WRIST LT W,4200122,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT WRIST RT W,4200119,CDM,350,RC,73201,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT ARTHRO SHOULDER LT,4200085,CDM,350,RC,73201,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,242.56,2524.48,
CT ARTHRO SHOULDER RT,4200086,CDM,350,RC,73201,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,242.56,2524.48,
CT CLAVICLE LT WWO,4200168,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT CLAVICLE RT WWO,4200165,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT ELBOW LT WWO,4200141,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT ELBOW RT WWO,4200138,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FOREARM LT WWO,4200132,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FOREARM RT WWO,4200129,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HAND LT WWO,4200114,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HAND RT WWO,4200111,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HUMERUS LT WWO,4200150,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HUMERUS RT WWO,4200147,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT SHOULDER LT WWO,4200159,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT SHOULDER RT WWO,4200156,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT WRIST LT WWO,4200123,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT WRIST RT WWO,4200120,CDM,350,RC,73202,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CTA UPPER EXTREMITY W,4200071,CDM,350,RC,73206,HCPCS,Outpatient,,,2587,2198.95,,2100.64,81.2,,,percent of total billed charges,81.2% of total billed charges,844.4,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,827.84,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,827.84,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1966.12,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,852.68,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,2328.3,90,,,percent of total billed charges,90% of total billed charges,2328.3,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2292.08,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,827.84,32,,,percent of total billed charges,32% of total billed charges,2069.6,80,,,percent of total billed charges,80% of total billed charges,2069.6,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2354.17,91,,,percent of total billed charges,91% of total billed charges,844.4,32.64,,,percent of total billed charges,32.64% of total billed charges,827.84,32,,,percent of total billed charges,32% of total billed charges,869.23,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,827.84,32,,,percent of total billed charges,32% of total billed charges,827.84,32,,,percent of total billed charges,32% of total billed charges,2380.04,92,,,percent of total billed charges,92% of total billed charges,279.34,2380.04,
CT ANKLE LT WO,4200184,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT ANKLE RT WO,4200181,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT FEMUR LT WO,4200211,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT FEMUR RT WO,4200208,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT FOOT LT WO,4200175,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT FOOT RT WO,4200172,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT HIP LT WO,4200220,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT HIP RT WO,4200217,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT KNEE LT WO,4200202,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT KNEE RT WO,4200199,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT TIB/FIB LT WO,4200193,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT TIB/FIB RT WO,4200190,CDM,350,RC,73700,HCPCS,Outpatient,,,1517,1289.45,,1231.8,81.2,,,percent of total billed charges,81.2% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,485.44,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1152.92,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,500,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1344.06,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,1213.6,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1380.47,91,,,percent of total billed charges,91% of total billed charges,495.15,32.64,,,percent of total billed charges,32.64% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,509.71,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,485.44,32,,,percent of total billed charges,32% of total billed charges,485.44,32,,,percent of total billed charges,32% of total billed charges,1395.64,92,,,percent of total billed charges,92% of total billed charges,113.15,1395.64,
CT HIP BILAT WO,4200223,CDM,350,RC,73700,HCPCS,Outpatient,,,3221,2737.85,,2615.45,81.2,,,percent of total billed charges,81.2% of total billed charges,1051.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,1030.72,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,1030.72,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,2447.96,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,1061.64,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,2898.9,90,,,percent of total billed charges,90% of total billed charges,2898.9,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,2853.81,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,1030.72,32,,,percent of total billed charges,32% of total billed charges,2576.8,80,,,percent of total billed charges,80% of total billed charges,2576.8,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,2931.11,91,,,percent of total billed charges,91% of total billed charges,1051.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1030.72,32,,,percent of total billed charges,32% of total billed charges,1082.26,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,1030.72,32,,,percent of total billed charges,32% of total billed charges,1030.72,32,,,percent of total billed charges,32% of total billed charges,2963.32,92,,,percent of total billed charges,92% of total billed charges,113.15,2963.32,
CT ARTHRO KNEE LT,4200080,CDM,350,RC,73701,HCPCS,Outpatient,,,1147,974.95,,931.36,81.2,,,percent of total billed charges,81.2% of total billed charges,374.38,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,367.04,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,367.04,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,871.72,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,378.05,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1032.3,90,,,percent of total billed charges,90% of total billed charges,1032.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1016.24,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,367.04,32,,,percent of total billed charges,32% of total billed charges,917.6,80,,,percent of total billed charges,80% of total billed charges,917.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1043.77,91,,,percent of total billed charges,91% of total billed charges,374.38,32.64,,,percent of total billed charges,32.64% of total billed charges,367.04,32,,,percent of total billed charges,32% of total billed charges,385.39,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,367.04,32,,,percent of total billed charges,32% of total billed charges,367.04,32,,,percent of total billed charges,32% of total billed charges,1055.24,92,,,percent of total billed charges,92% of total billed charges,242.56,1055.24,
CT ARTHRO KNEE RT,4200079,CDM,350,RC,73701,HCPCS,Outpatient,,,1147,974.95,,931.36,81.2,,,percent of total billed charges,81.2% of total billed charges,374.38,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,367.04,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,367.04,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,871.72,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,378.05,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1032.3,90,,,percent of total billed charges,90% of total billed charges,1032.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1016.24,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,367.04,32,,,percent of total billed charges,32% of total billed charges,917.6,80,,,percent of total billed charges,80% of total billed charges,917.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1043.77,91,,,percent of total billed charges,91% of total billed charges,374.38,32.64,,,percent of total billed charges,32.64% of total billed charges,367.04,32,,,percent of total billed charges,32% of total billed charges,385.39,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,367.04,32,,,percent of total billed charges,32% of total billed charges,367.04,32,,,percent of total billed charges,32% of total billed charges,1055.24,92,,,percent of total billed charges,92% of total billed charges,242.56,1055.24,
CT ANKLE LT W,4200185,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT ANKLE RT W,4200182,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FEMUR LT W,4200212,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FEMUR RT W,4200209,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FOOT LT W,4200176,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FOOT RT W,4200173,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HIP LT W,4200221,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HIP RT W,4200218,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT KNEE LT W,4200203,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT KNEE RT W,4200200,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT TIB/FIB LT W,4200194,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT TIB/FIB RT W,4200191,CDM,350,RC,73701,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT ANKLE LT WWO,4200186,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT ANKLE RT WWO,4200183,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FEMUR LT WWO,4200213,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FEMUR RT WWO,4200210,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FOOT LT WWO,4200177,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT FOOT RT WWO,4200174,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HIP LT WWO,4200222,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT HIP RT WWO,4200219,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT KNEE LT WWO,4200204,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT KNEE RT WWO,4200201,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT TIB/FIB LT WWO,4200195,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CT TIB/FIB RT WWO,4200192,CDM,350,RC,73702,HCPCS,Outpatient,,,1841,1564.85,,1494.89,81.2,,,percent of total billed charges,81.2% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,589.12,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1399.16,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,606.79,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1656.9,90,,,percent of total billed charges,90% of total billed charges,1656.9,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1631.13,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,1472.8,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1675.31,91,,,percent of total billed charges,91% of total billed charges,600.9,32.64,,,percent of total billed charges,32.64% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,618.58,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,589.12,32,,,percent of total billed charges,32% of total billed charges,589.12,32,,,percent of total billed charges,32% of total billed charges,1693.72,92,,,percent of total billed charges,92% of total billed charges,242.56,1693.72,
CTA LOW BILAT EXT W/ IV CONTRAST W/PP,4200074,CDM,352,RC,73706,HCPCS,Outpatient,,,293,249.05,,237.92,81.2,,,percent of total billed charges,81.2% of total billed charges,95.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,93.76,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,93.76,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,222.68,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,96.57,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,263.7,90,,,percent of total billed charges,90% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,259.6,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,93.76,32,,,percent of total billed charges,32% of total billed charges,234.4,80,,,percent of total billed charges,80% of total billed charges,234.4,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,266.63,91,,,percent of total billed charges,91% of total billed charges,95.64,32.64,,,percent of total billed charges,32.64% of total billed charges,93.76,32,,,percent of total billed charges,32% of total billed charges,98.45,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,93.76,32,,,percent of total billed charges,32% of total billed charges,93.76,32,,,percent of total billed charges,32% of total billed charges,269.56,92,,,percent of total billed charges,92% of total billed charges,93.76,1027,
CTA LOW LT EXT W/ IV CONTRAST W/PP,4200073,CDM,352,RC,73706,HCPCS,Outpatient,,,293,249.05,,237.92,81.2,,,percent of total billed charges,81.2% of total billed charges,95.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,93.76,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,93.76,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,222.68,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,96.57,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,263.7,90,,,percent of total billed charges,90% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,259.6,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,93.76,32,,,percent of total billed charges,32% of total billed charges,234.4,80,,,percent of total billed charges,80% of total billed charges,234.4,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,266.63,91,,,percent of total billed charges,91% of total billed charges,95.64,32.64,,,percent of total billed charges,32.64% of total billed charges,93.76,32,,,percent of total billed charges,32% of total billed charges,98.45,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,93.76,32,,,percent of total billed charges,32% of total billed charges,93.76,32,,,percent of total billed charges,32% of total billed charges,269.56,92,,,percent of total billed charges,92% of total billed charges,93.76,1027,
CTA LOW RT EXT W/ IV CONTRAST W/PP,4200072,CDM,352,RC,73706,HCPCS,Outpatient,,,293,249.05,,237.92,81.2,,,percent of total billed charges,81.2% of total billed charges,95.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,93.76,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,93.76,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,222.68,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,96.57,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,263.7,90,,,percent of total billed charges,90% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,259.6,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,93.76,32,,,percent of total billed charges,32% of total billed charges,234.4,80,,,percent of total billed charges,80% of total billed charges,234.4,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,266.63,91,,,percent of total billed charges,91% of total billed charges,95.64,32.64,,,percent of total billed charges,32.64% of total billed charges,93.76,32,,,percent of total billed charges,32% of total billed charges,98.45,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,93.76,32,,,percent of total billed charges,32% of total billed charges,93.76,32,,,percent of total billed charges,32% of total billed charges,269.56,92,,,percent of total billed charges,92% of total billed charges,93.76,1027,
CT ABD WO,4200002,CDM,350,RC,74150,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT ADRENAL PROTOCOL WO,4200099,CDM,350,RC,74150,HCPCS,Outpatient,,,1410,1198.5,,1144.92,81.2,,,percent of total billed charges,81.2% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,451.2,32,,,percent of total billed charges,32% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1071.6,100,,,Case rate,pays based on per visit,116.54,103,,,Fee Schedule,pays based on EAPG rates,464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,118.8,105,,,Fee Schedule,pays based on EAPG rates,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1249.26,88.6,,,percent of total billed charges,88.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,1128,80,,,percent of total billed charges,80% of total billed charges,113.15,100,,,Fee Schedule,pays based on EAPG rates,1283.1,91,,,percent of total billed charges,91% of total billed charges,460.22,32.64,,,percent of total billed charges,32.64% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,473.76,33.6,,,percent of total billed charges,33.6% of total billed charges,116.54,103,,,Fee Schedule,pays based on EAPG rates,451.2,32,,,percent of total billed charges,32% of total billed charges,451.2,32,,,percent of total billed charges,32% of total billed charges,1297.2,92,,,percent of total billed charges,92% of total billed charges,113.15,1297.2,
CT ABD W,4200003,CDM,350,RC,74160,HCPCS,Outpatient,,,1694,1439.9,,1375.53,81.2,,,percent of total billed charges,81.2% of total billed charges,552.92,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,542.08,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,542.08,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1287.44,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,558.34,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1524.6,90,,,percent of total billed charges,90% of total billed charges,1524.6,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1500.88,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,542.08,32,,,percent of total billed charges,32% of total billed charges,1355.2,80,,,percent of total billed charges,80% of total billed charges,1355.2,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1541.54,91,,,percent of total billed charges,91% of total billed charges,552.92,32.64,,,percent of total billed charges,32.64% of total billed charges,542.08,32,,,percent of total billed charges,32% of total billed charges,569.18,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,542.08,32,,,percent of total billed charges,32% of total billed charges,542.08,32,,,percent of total billed charges,32% of total billed charges,1558.48,92,,,percent of total billed charges,92% of total billed charges,242.56,1558.48,
CT ABD HEMANGIOMA PROTOCOL WWO,4200055,CDM,350,RC,74170,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT ABD WWO,4200053,CDM,350,RC,74170,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT ADRENAL PROTOCOL WWO W/DELAY,4200100,CDM,350,RC,74170,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT LIVER MULTIPHASE,4200101,CDM,350,RC,74170,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT PANCREAS WWO W/DELAY,4200103,CDM,350,RC,74170,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CT RENAL PROTOCOL WWO,4200098,CDM,350,RC,74170,HCPCS,Outpatient,,,2110,1793.5,,1713.32,81.2,,,percent of total billed charges,81.2% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,675.2,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1603.6,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,695.46,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1869.46,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,1688,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,1920.1,91,,,percent of total billed charges,91% of total billed charges,688.7,32.64,,,percent of total billed charges,32.64% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,708.96,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,675.2,32,,,percent of total billed charges,32% of total billed charges,675.2,32,,,percent of total billed charges,32% of total billed charges,1941.2,92,,,percent of total billed charges,92% of total billed charges,242.56,1941.2,
CTA ABD/PEL W,4200078,CDM,350,RC,74174,HCPCS,Outpatient,,,2571,2185.35,,2087.65,81.2,,,percent of total billed charges,81.2% of total billed charges,839.17,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,822.72,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,822.72,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1953.96,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,847.4,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,2313.9,90,,,percent of total billed charges,90% of total billed charges,2313.9,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2277.91,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,822.72,32,,,percent of total billed charges,32% of total billed charges,2056.8,80,,,percent of total billed charges,80% of total billed charges,2056.8,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2339.61,91,,,percent of total billed charges,91% of total billed charges,839.17,32.64,,,percent of total billed charges,32.64% of total billed charges,822.72,32,,,percent of total billed charges,32% of total billed charges,863.86,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,822.72,32,,,percent of total billed charges,32% of total billed charges,822.72,32,,,percent of total billed charges,32% of total billed charges,2365.32,92,,,percent of total billed charges,92% of total billed charges,279.34,2365.32,
CTA ABD W,4200057,CDM,350,RC,74175,HCPCS,Outpatient,,,1814,1541.9,,1472.97,81.2,,,percent of total billed charges,81.2% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,580.48,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1378.64,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,597.89,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,1607.2,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,1451.2,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,1650.74,91,,,percent of total billed charges,91% of total billed charges,592.09,32.64,,,percent of total billed charges,32.64% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,609.5,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,580.48,32,,,percent of total billed charges,32% of total billed charges,580.48,32,,,percent of total billed charges,32% of total billed charges,1668.88,92,,,percent of total billed charges,92% of total billed charges,279.34,1668.88,
CTA ABD WWO,4200235,CDM,350,RC,74175,HCPCS,Outpatient,,,2514,2136.9,,2041.37,81.2,,,percent of total billed charges,81.2% of total billed charges,820.57,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,804.48,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,804.48,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1910.64,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,828.61,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,2262.6,90,,,percent of total billed charges,90% of total billed charges,2262.6,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2227.4,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,804.48,32,,,percent of total billed charges,32% of total billed charges,2011.2,80,,,percent of total billed charges,80% of total billed charges,2011.2,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2287.74,91,,,percent of total billed charges,91% of total billed charges,820.57,32.64,,,percent of total billed charges,32.64% of total billed charges,804.48,32,,,percent of total billed charges,32% of total billed charges,844.7,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,804.48,32,,,percent of total billed charges,32% of total billed charges,804.48,32,,,percent of total billed charges,32% of total billed charges,2312.88,92,,,percent of total billed charges,92% of total billed charges,279.34,2312.88,
CT ABD/PEL WO,4200076,CDM,352,RC,74176,HCPCS,Outpatient,,,2437,2071.45,,1978.84,81.2,,,percent of total billed charges,81.2% of total billed charges,795.44,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,779.84,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,779.84,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1852.12,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,803.24,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,2193.3,90,,,percent of total billed charges,90% of total billed charges,2193.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2159.18,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,779.84,32,,,percent of total billed charges,32% of total billed charges,1949.6,80,,,percent of total billed charges,80% of total billed charges,1949.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2217.67,91,,,percent of total billed charges,91% of total billed charges,795.44,32.64,,,percent of total billed charges,32.64% of total billed charges,779.84,32,,,percent of total billed charges,32% of total billed charges,818.83,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,779.84,32,,,percent of total billed charges,32% of total billed charges,779.84,32,,,percent of total billed charges,32% of total billed charges,2242.04,92,,,percent of total billed charges,92% of total billed charges,242.56,2242.04,
CT STONE SEARCH,4000062,CDM,352,RC,74176,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,242.56,2451.8,
CT ABD/PEL WWO,4200066,CDM,350,RC,74178,HCPCS,Outpatient,,,3237,2751.45,,2628.44,81.2,,,percent of total billed charges,81.2% of total billed charges,1056.56,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,1035.84,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,1035.84,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,2460.12,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,1066.92,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,2913.3,90,,,percent of total billed charges,90% of total billed charges,2913.3,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2867.98,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,1035.84,32,,,percent of total billed charges,32% of total billed charges,2589.6,80,,,percent of total billed charges,80% of total billed charges,2589.6,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2945.67,91,,,percent of total billed charges,91% of total billed charges,1056.56,32.64,,,percent of total billed charges,32.64% of total billed charges,1035.84,32,,,percent of total billed charges,32% of total billed charges,1087.63,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,1035.84,32,,,percent of total billed charges,32% of total billed charges,1035.84,32,,,percent of total billed charges,32% of total billed charges,2978.04,92,,,percent of total billed charges,92% of total billed charges,242.56,2978.04,
CTA RUN OFF W,4200063,CDM,350,RC,75635,HCPCS,Outpatient,,,2822,2398.7,,2291.46,81.2,,,percent of total billed charges,81.2% of total billed charges,921.1,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,903.04,32,,,percent of total billed charges,32% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,903.04,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,2144.72,100,,,Case rate,pays based on per visit,287.72,103,,,Fee Schedule,pays based on EAPG rates,930.13,32.96,,,percent of total billed charges,32.96% of total billed charges,293.31,105,,,Fee Schedule,pays based on EAPG rates,2539.8,90,,,percent of total billed charges,90% of total billed charges,2539.8,90,,,percent of total billed charges,90% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2500.29,88.6,,,percent of total billed charges,88.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,903.04,32,,,percent of total billed charges,32% of total billed charges,2257.6,80,,,percent of total billed charges,80% of total billed charges,2257.6,80,,,percent of total billed charges,80% of total billed charges,279.34,100,,,Fee Schedule,pays based on EAPG rates,2568.02,91,,,percent of total billed charges,91% of total billed charges,921.1,32.64,,,percent of total billed charges,32.64% of total billed charges,903.04,32,,,percent of total billed charges,32% of total billed charges,948.19,33.6,,,percent of total billed charges,33.6% of total billed charges,287.72,103,,,Fee Schedule,pays based on EAPG rates,903.04,32,,,percent of total billed charges,32% of total billed charges,903.04,32,,,percent of total billed charges,32% of total billed charges,2596.24,92,,,percent of total billed charges,92% of total billed charges,279.34,2596.24,
CT 3D RENDER 1,4200034,CDM,350,RC,76376,HCPCS,Outpatient,,,1037,881.45,,842.04,81.2,,,percent of total billed charges,81.2% of total billed charges,338.48,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,331.84,32,,,percent of total billed charges,32% of total billed charges,55.09,103,,,Fee Schedule,pays based on EAPG rates,331.84,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,788.12,100,,,Case rate,pays based on per visit,55.09,103,,,Fee Schedule,pays based on EAPG rates,341.8,32.96,,,percent of total billed charges,32.96% of total billed charges,56.16,105,,,Fee Schedule,pays based on EAPG rates,933.3,90,,,percent of total billed charges,90% of total billed charges,933.3,90,,,percent of total billed charges,90% of total billed charges,53.48,100,,,Fee Schedule,pays based on EAPG rates,918.78,88.6,,,percent of total billed charges,88.6% of total billed charges,55.09,103,,,Fee Schedule,pays based on EAPG rates,331.84,32,,,percent of total billed charges,32% of total billed charges,829.6,80,,,percent of total billed charges,80% of total billed charges,829.6,80,,,percent of total billed charges,80% of total billed charges,53.48,100,,,Fee Schedule,pays based on EAPG rates,943.67,91,,,percent of total billed charges,91% of total billed charges,338.48,32.64,,,percent of total billed charges,32.64% of total billed charges,331.84,32,,,percent of total billed charges,32% of total billed charges,348.43,33.6,,,percent of total billed charges,33.6% of total billed charges,55.09,103,,,Fee Schedule,pays based on EAPG rates,331.84,32,,,percent of total billed charges,32% of total billed charges,331.84,32,,,percent of total billed charges,32% of total billed charges,954.04,92,,,percent of total billed charges,92% of total billed charges,53.48,1027,
CT GUIDANCE FOR CYST ASPIRATIO,4200004,CDM,350,RC,77012,HCPCS,Outpatient,,,1740,1479,,1412.88,81.2,,,percent of total billed charges,81.2% of total billed charges,567.94,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,556.8,32,,,percent of total billed charges,32% of total billed charges,70.68,103,,,Fee Schedule,pays based on EAPG rates,556.8,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,1322.4,100,,,Case rate,pays based on per visit,70.68,103,,,Fee Schedule,pays based on EAPG rates,573.5,32.96,,,percent of total billed charges,32.96% of total billed charges,72.05,105,,,Fee Schedule,pays based on EAPG rates,1566,90,,,percent of total billed charges,90% of total billed charges,1566,90,,,percent of total billed charges,90% of total billed charges,68.62,100,,,Fee Schedule,pays based on EAPG rates,1541.64,88.6,,,percent of total billed charges,88.6% of total billed charges,70.68,103,,,Fee Schedule,pays based on EAPG rates,556.8,32,,,percent of total billed charges,32% of total billed charges,1392,80,,,percent of total billed charges,80% of total billed charges,1392,80,,,percent of total billed charges,80% of total billed charges,68.62,100,,,Fee Schedule,pays based on EAPG rates,1583.4,91,,,percent of total billed charges,91% of total billed charges,567.94,32.64,,,percent of total billed charges,32.64% of total billed charges,556.8,32,,,percent of total billed charges,32% of total billed charges,584.64,33.6,,,percent of total billed charges,33.6% of total billed charges,70.68,103,,,Fee Schedule,pays based on EAPG rates,556.8,32,,,percent of total billed charges,32% of total billed charges,556.8,32,,,percent of total billed charges,32% of total billed charges,1600.8,92,,,percent of total billed charges,92% of total billed charges,68.62,1600.8,
CT GUIDANCE FOR NEEDLE BX,4200005,CDM,350,RC,77012,HCPCS,Outpatient,,,2822,2398.7,,2291.46,81.2,,,percent of total billed charges,81.2% of total billed charges,921.1,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,903.04,32,,,percent of total billed charges,32% of total billed charges,70.68,103,,,Fee Schedule,pays based on EAPG rates,903.04,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,2144.72,100,,,Case rate,pays based on per visit,70.68,103,,,Fee Schedule,pays based on EAPG rates,930.13,32.96,,,percent of total billed charges,32.96% of total billed charges,72.05,105,,,Fee Schedule,pays based on EAPG rates,2539.8,90,,,percent of total billed charges,90% of total billed charges,2539.8,90,,,percent of total billed charges,90% of total billed charges,68.62,100,,,Fee Schedule,pays based on EAPG rates,2500.29,88.6,,,percent of total billed charges,88.6% of total billed charges,70.68,103,,,Fee Schedule,pays based on EAPG rates,903.04,32,,,percent of total billed charges,32% of total billed charges,2257.6,80,,,percent of total billed charges,80% of total billed charges,2257.6,80,,,percent of total billed charges,80% of total billed charges,68.62,100,,,Fee Schedule,pays based on EAPG rates,2568.02,91,,,percent of total billed charges,91% of total billed charges,921.1,32.64,,,percent of total billed charges,32.64% of total billed charges,903.04,32,,,percent of total billed charges,32% of total billed charges,948.19,33.6,,,percent of total billed charges,33.6% of total billed charges,70.68,103,,,Fee Schedule,pays based on EAPG rates,903.04,32,,,percent of total billed charges,32% of total billed charges,903.04,32,,,percent of total billed charges,32% of total billed charges,2596.24,92,,,percent of total billed charges,92% of total billed charges,68.62,2596.24,
DSMT RN GROUP PER 30 MINUTES,9200007,CDM,942,RC,99211,HCPCS,Outpatient,,,67,56.95,,54.4,81.2,,,percent of total billed charges,81.2% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,50.92,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,22.08,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,60.3,90,,,percent of total billed charges,90% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,59.36,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,60.97,91,,,percent of total billed charges,91% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,22.51,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,61.64,92,,,percent of total billed charges,92% of total billed charges,21.44,61.64,
DSMT RD GROUP PER 30 MINUTES,9200008,CDM,942,RC,99211,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,22.4,64.4,
DSMT RD INDIVIDUAL PER 30 MIN,9200006,CDM,942,RC,99211,HCPCS,Outpatient,,,119,101.15,,96.63,81.2,,,percent of total billed charges,81.2% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,90.44,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.22,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,105.43,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,108.29,91,,,percent of total billed charges,91% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,39.98,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,109.48,92,,,percent of total billed charges,92% of total billed charges,38.08,109.48,
DSMT RN INDIVIDUAL PER 30 MIN,9200005,CDM,942,RC,99211,HCPCS,Outpatient,,,119,101.15,,96.63,81.2,,,percent of total billed charges,81.2% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,90.44,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.22,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,105.43,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,108.29,91,,,percent of total billed charges,91% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,39.98,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,109.48,92,,,percent of total billed charges,92% of total billed charges,38.08,109.48,
NUTRITION THER.INITIAL INDIV(PER 15 MIN),1400001,CDM,942,RC,97802,HCPCS,Outpatient,,,66,56.1,,53.59,81.2,,,percent of total billed charges,81.2% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,52.81,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,50.16,76,,,percent of total billed charges,76% of total billed charges,52.81,103,,,Fee Schedule,pays based on EAPG rates,21.75,32.96,,,percent of total billed charges,32.96% of total billed charges,53.84,105,,,Fee Schedule,pays based on EAPG rates,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,51.27,100,,,Fee Schedule,pays based on EAPG rates,58.48,88.6,,,percent of total billed charges,88.6% of total billed charges,52.81,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,51.27,100,,,Fee Schedule,pays based on EAPG rates,60.06,91,,,percent of total billed charges,91% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,22.18,33.6,,,percent of total billed charges,33.6% of total billed charges,52.81,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,60.72,92,,,percent of total billed charges,92% of total billed charges,21.12,60.72,
NUTRITION THER REASSESS INDIV(PER 15 MIN,1400002,CDM,942,RC,97803,HCPCS,Outpatient,,,30,25.5,,24.36,81.2,,,percent of total billed charges,81.2% of total billed charges,9.79,32.64,,,percent of total billed charges,32.64% of total billed charges,22.2,74,,,percent of total billed charges,74% of total billed charges,22.2,74,,,percent of total billed charges,74% of total billed charges,9.6,32,,,percent of total billed charges,32% of total billed charges,52.81,103,,,Fee Schedule,pays based on EAPG rates,9.6,32,,,percent of total billed charges,32% of total billed charges,21.3,71,,,percent of total billed charges,71% of total billed charges,21.3,71,,,percent of total billed charges,71% of total billed charges,20.1,67,,,percent of total billed charges,67% of total billed charges,20.1,67,,,percent of total billed charges,67% of total billed charges,21.3,71,,,percent of total billed charges,71% of total billed charges,22.8,76,,,percent of total billed charges,76% of total billed charges,52.81,103,,,Fee Schedule,pays based on EAPG rates,9.89,32.96,,,percent of total billed charges,32.96% of total billed charges,53.84,105,,,Fee Schedule,pays based on EAPG rates,27,90,,,percent of total billed charges,90% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,51.27,100,,,Fee Schedule,pays based on EAPG rates,26.58,88.6,,,percent of total billed charges,88.6% of total billed charges,52.81,103,,,Fee Schedule,pays based on EAPG rates,9.6,32,,,percent of total billed charges,32% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,51.27,100,,,Fee Schedule,pays based on EAPG rates,27.3,91,,,percent of total billed charges,91% of total billed charges,9.79,32.64,,,percent of total billed charges,32.64% of total billed charges,9.6,32,,,percent of total billed charges,32% of total billed charges,10.08,33.6,,,percent of total billed charges,33.6% of total billed charges,52.81,103,,,Fee Schedule,pays based on EAPG rates,9.6,32,,,percent of total billed charges,32% of total billed charges,9.6,32,,,percent of total billed charges,32% of total billed charges,27.6,92,,,percent of total billed charges,92% of total billed charges,9.6,53.84,
BONE MARROW BIOPSY AND ASPIRATION,6400045,CDM,360,RC,38222,HCPCS,Outpatient,,,196,166.6,,159.15,81.2,,,percent of total billed charges,81.2% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,148.96,76,,,percent of total billed charges,76% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,64.6,32.96,,,percent of total billed charges,32.96% of total billed charges,855.18,105,,,Fee Schedule,pays based on EAPG rates,176.4,90,,,percent of total billed charges,90% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,814.46,100,,,Fee Schedule,pays based on EAPG rates,173.66,88.6,,,percent of total billed charges,88.6% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,814.46,100,,,Fee Schedule,pays based on EAPG rates,178.36,91,,,percent of total billed charges,91% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,65.86,33.6,,,percent of total billed charges,33.6% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,180.32,92,,,percent of total billed charges,92% of total billed charges,62.72,855.18,
ESOPHAGOSCOPY FLEX BALLOON DILAT <30MM,6400067,CDM,750,RC,43220,HCPCS,Outpatient,,,2298,1953.3,,1865.98,81.2,,,percent of total billed charges,81.2% of total billed charges,750.07,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,735.36,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,735.36,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,1746.48,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,757.42,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,2068.2,90,,,percent of total billed charges,90% of total billed charges,2068.2,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2036.03,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,735.36,32,,,percent of total billed charges,32% of total billed charges,1838.4,80,,,percent of total billed charges,80% of total billed charges,1838.4,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2091.18,91,,,percent of total billed charges,91% of total billed charges,750.07,32.64,,,percent of total billed charges,32.64% of total billed charges,735.36,32,,,percent of total billed charges,32% of total billed charges,772.13,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,735.36,32,,,percent of total billed charges,32% of total billed charges,735.36,32,,,percent of total billed charges,32% of total billed charges,2114.16,92,,,percent of total billed charges,92% of total billed charges,480.68,3671,
EGD,6400004,CDM,750,RC,43235,HCPCS,Outpatient,,,2305,1959.25,,1871.66,81.2,,,percent of total billed charges,81.2% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,737.6,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,737.6,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,1751.8,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,759.73,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,2074.5,90,,,percent of total billed charges,90% of total billed charges,2074.5,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2042.23,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,737.6,32,,,percent of total billed charges,32% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2097.55,91,,,percent of total billed charges,91% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,774.48,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,737.6,32,,,percent of total billed charges,32% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,2120.6,92,,,percent of total billed charges,92% of total billed charges,480.68,3671,
EGD WITH BIOPSY,6400007,CDM,750,RC,43239,HCPCS,Outpatient,,,3262,2772.7,,2648.74,81.2,,,percent of total billed charges,81.2% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1043.84,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,2479.12,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,1075.16,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,2935.8,90,,,percent of total billed charges,90% of total billed charges,2935.8,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2890.13,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2968.42,91,,,percent of total billed charges,91% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,1096.03,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,3001.04,92,,,percent of total billed charges,92% of total billed charges,480.68,4917,
EGD W/ STRICTURE DILATATION,6400070,CDM,750,RC,43245,HCPCS,Outpatient,,,2298,1953.3,,1865.98,81.2,,,percent of total billed charges,81.2% of total billed charges,750.07,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,735.36,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,735.36,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,1746.48,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,757.42,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,2068.2,90,,,percent of total billed charges,90% of total billed charges,2068.2,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2036.03,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,735.36,32,,,percent of total billed charges,32% of total billed charges,1838.4,80,,,percent of total billed charges,80% of total billed charges,1838.4,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2091.18,91,,,percent of total billed charges,91% of total billed charges,750.07,32.64,,,percent of total billed charges,32.64% of total billed charges,735.36,32,,,percent of total billed charges,32% of total billed charges,772.13,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,735.36,32,,,percent of total billed charges,32% of total billed charges,735.36,32,,,percent of total billed charges,32% of total billed charges,2114.16,92,,,percent of total billed charges,92% of total billed charges,480.68,4917,
EGD W/ PEG,6400010,CDM,750,RC,43246,HCPCS,Outpatient,,,2059,1750.15,,1671.91,81.2,,,percent of total billed charges,81.2% of total billed charges,672.06,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,658.88,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,658.88,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,1564.84,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,678.65,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,1853.1,90,,,percent of total billed charges,90% of total billed charges,1853.1,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,1824.27,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,658.88,32,,,percent of total billed charges,32% of total billed charges,1647.2,80,,,percent of total billed charges,80% of total billed charges,1647.2,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,1873.69,91,,,percent of total billed charges,91% of total billed charges,672.06,32.64,,,percent of total billed charges,32.64% of total billed charges,658.88,32,,,percent of total billed charges,32% of total billed charges,691.82,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,658.88,32,,,percent of total billed charges,32% of total billed charges,658.88,32,,,percent of total billed charges,32% of total billed charges,1894.28,92,,,percent of total billed charges,92% of total billed charges,480.68,4917,
EGD W/ RMVL FOREIGN BODY,6400058,CDM,750,RC,43247,HCPCS,Outpatient,,,3262,2772.7,,2648.74,81.2,,,percent of total billed charges,81.2% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1043.84,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,2479.12,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,1075.16,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,2935.8,90,,,percent of total billed charges,90% of total billed charges,2935.8,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2890.13,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2968.42,91,,,percent of total billed charges,91% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,1096.03,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,3001.04,92,,,percent of total billed charges,92% of total billed charges,480.68,4917,
EGD W/ GUIDE WIRE AND DILATOR,6400065,CDM,750,RC,43248,HCPCS,Outpatient,,,3262,2772.7,,2648.74,81.2,,,percent of total billed charges,81.2% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1043.84,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,2479.12,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,1075.16,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,2935.8,90,,,percent of total billed charges,90% of total billed charges,2935.8,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2890.13,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2968.42,91,,,percent of total billed charges,91% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,1096.03,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,3001.04,92,,,percent of total billed charges,92% of total billed charges,480.68,4917,
EGD W/ ESOPHAGEAL DILATATION,6400011,CDM,750,RC,43249,HCPCS,Outpatient,,,2298,1953.3,,1865.98,81.2,,,percent of total billed charges,81.2% of total billed charges,750.07,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,735.36,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,735.36,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,1746.48,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,757.42,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,2068.2,90,,,percent of total billed charges,90% of total billed charges,2068.2,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2036.03,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,735.36,32,,,percent of total billed charges,32% of total billed charges,1838.4,80,,,percent of total billed charges,80% of total billed charges,1838.4,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,2091.18,91,,,percent of total billed charges,91% of total billed charges,750.07,32.64,,,percent of total billed charges,32.64% of total billed charges,735.36,32,,,percent of total billed charges,32% of total billed charges,772.13,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,735.36,32,,,percent of total billed charges,32% of total billed charges,735.36,32,,,percent of total billed charges,32% of total billed charges,2114.16,92,,,percent of total billed charges,92% of total billed charges,480.68,4917,
EGD W/ POLYPECTOMY (SNARE),6400021,CDM,750,RC,43251,HCPCS,Outpatient,,,3483,2960.55,,2828.2,81.2,,,percent of total billed charges,81.2% of total billed charges,1136.85,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1114.56,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1114.56,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,2647.08,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,1148,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,3134.7,90,,,percent of total billed charges,90% of total billed charges,3134.7,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,3085.94,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1114.56,32,,,percent of total billed charges,32% of total billed charges,2786.4,80,,,percent of total billed charges,80% of total billed charges,2786.4,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,3169.53,91,,,percent of total billed charges,91% of total billed charges,1136.85,32.64,,,percent of total billed charges,32.64% of total billed charges,1114.56,32,,,percent of total billed charges,32% of total billed charges,1170.29,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1114.56,32,,,percent of total billed charges,32% of total billed charges,1114.56,32,,,percent of total billed charges,32% of total billed charges,3204.36,92,,,percent of total billed charges,92% of total billed charges,480.68,4917,
EGD W/ CONTROL OF BLEEDING,6400057,CDM,750,RC,43255,HCPCS,Outpatient,,,3483,2960.55,,2828.2,81.2,,,percent of total billed charges,81.2% of total billed charges,1136.85,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1114.56,32,,,percent of total billed charges,32% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1114.56,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,2647.08,100,,,Fee Schedule,pays based on grouper fee Schedule,495.1,103,,,Fee Schedule,pays based on EAPG rates,1148,32.96,,,percent of total billed charges,32.96% of total billed charges,504.71,105,,,Fee Schedule,pays based on EAPG rates,3134.7,90,,,percent of total billed charges,90% of total billed charges,3134.7,90,,,percent of total billed charges,90% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,3085.94,88.6,,,percent of total billed charges,88.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1114.56,32,,,percent of total billed charges,32% of total billed charges,2786.4,80,,,percent of total billed charges,80% of total billed charges,2786.4,80,,,percent of total billed charges,80% of total billed charges,480.68,100,,,Fee Schedule,pays based on EAPG rates,3169.53,91,,,percent of total billed charges,91% of total billed charges,1136.85,32.64,,,percent of total billed charges,32.64% of total billed charges,1114.56,32,,,percent of total billed charges,32% of total billed charges,1170.29,33.6,,,percent of total billed charges,33.6% of total billed charges,495.1,103,,,Fee Schedule,pays based on EAPG rates,1114.56,32,,,percent of total billed charges,32% of total billed charges,1114.56,32,,,percent of total billed charges,32% of total billed charges,3204.36,92,,,percent of total billed charges,92% of total billed charges,480.68,4917,
ESOPHAGEAL DILATION - UNGUIDED,6400073,CDM,750,RC,43450,HCPCS,Outpatient,,,2600,2210,,2111.2,81.2,,,percent of total billed charges,81.2% of total billed charges,848.64,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,832,32,,,percent of total billed charges,32% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,832,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,1976,100,,,Fee Schedule,pays based on grouper fee Schedule,189.98,103,,,Fee Schedule,pays based on EAPG rates,856.96,32.96,,,percent of total billed charges,32.96% of total billed charges,193.67,105,,,Fee Schedule,pays based on EAPG rates,2340,90,,,percent of total billed charges,90% of total billed charges,2340,90,,,percent of total billed charges,90% of total billed charges,184.45,100,,,Fee Schedule,pays based on EAPG rates,2303.6,88.6,,,percent of total billed charges,88.6% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,832,32,,,percent of total billed charges,32% of total billed charges,2080,80,,,percent of total billed charges,80% of total billed charges,2080,80,,,percent of total billed charges,80% of total billed charges,184.45,100,,,Fee Schedule,pays based on EAPG rates,2366,91,,,percent of total billed charges,91% of total billed charges,848.64,32.64,,,percent of total billed charges,32.64% of total billed charges,832,32,,,percent of total billed charges,32% of total billed charges,873.6,33.6,,,percent of total billed charges,33.6% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,832,32,,,percent of total billed charges,32% of total billed charges,832,32,,,percent of total billed charges,32% of total billed charges,2392,92,,,percent of total billed charges,92% of total billed charges,184.45,3671,
ENTEROSCOPY 2ND PRTN W CONTROL BLEED,6400072,CDM,750,RC,44366,HCPCS,Outpatient,,,5484,4661.4,,4453.01,81.2,,,percent of total billed charges,81.2% of total billed charges,1789.98,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1754.88,32,,,percent of total billed charges,32% of total billed charges,952.18,103,,,Fee Schedule,pays based on EAPG rates,1754.88,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4167.84,100,,,Fee Schedule,pays based on grouper fee Schedule,952.18,103,,,Fee Schedule,pays based on EAPG rates,1807.53,32.96,,,percent of total billed charges,32.96% of total billed charges,970.67,105,,,Fee Schedule,pays based on EAPG rates,4935.6,90,,,percent of total billed charges,90% of total billed charges,4935.6,90,,,percent of total billed charges,90% of total billed charges,924.44,100,,,Fee Schedule,pays based on EAPG rates,4858.82,88.6,,,percent of total billed charges,88.6% of total billed charges,952.18,103,,,Fee Schedule,pays based on EAPG rates,1754.88,32,,,percent of total billed charges,32% of total billed charges,4387.2,80,,,percent of total billed charges,80% of total billed charges,4387.2,80,,,percent of total billed charges,80% of total billed charges,924.44,100,,,Fee Schedule,pays based on EAPG rates,4990.44,91,,,percent of total billed charges,91% of total billed charges,1789.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1754.88,32,,,percent of total billed charges,32% of total billed charges,1842.62,33.6,,,percent of total billed charges,33.6% of total billed charges,952.18,103,,,Fee Schedule,pays based on EAPG rates,1754.88,32,,,percent of total billed charges,32% of total billed charges,1754.88,32,,,percent of total billed charges,32% of total billed charges,5045.28,92,,,percent of total billed charges,92% of total billed charges,924.44,5045.28,
ILEOSCOPY (STOMA) W/ BIOPSY SINGLE/MULTI,6400071,CDM,750,RC,44382,HCPCS,Outpatient,,,2305,1959.25,,1871.66,81.2,,,percent of total billed charges,81.2% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,737.6,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,737.6,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,1751.8,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,759.73,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,2074.5,90,,,percent of total billed charges,90% of total billed charges,2074.5,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2042.23,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,737.6,32,,,percent of total billed charges,32% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2097.55,91,,,percent of total billed charges,91% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,774.48,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,737.6,32,,,percent of total billed charges,32% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,2120.6,92,,,percent of total billed charges,92% of total billed charges,548.4,3671,
COLONOSCOPY THRU STOMA,6400062,CDM,750,RC,44388,HCPCS,Outpatient,,,2305,1959.25,,1871.66,81.2,,,percent of total billed charges,81.2% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,737.6,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,737.6,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,1751.8,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,759.73,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,2074.5,90,,,percent of total billed charges,90% of total billed charges,2074.5,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2042.23,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,737.6,32,,,percent of total billed charges,32% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2097.55,91,,,percent of total billed charges,91% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,774.48,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,737.6,32,,,percent of total billed charges,32% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,2120.6,92,,,percent of total billed charges,92% of total billed charges,548.4,3671,
COLON (STOMA) W/ BIOPSY,6400063,CDM,750,RC,44389,HCPCS,Outpatient,,,3262,2772.7,,2648.74,81.2,,,percent of total billed charges,81.2% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,1043.84,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,2479.12,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,1075.16,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,2935.8,90,,,percent of total billed charges,90% of total billed charges,2935.8,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2890.13,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2968.42,91,,,percent of total billed charges,91% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,1096.03,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,3001.04,92,,,percent of total billed charges,92% of total billed charges,548.4,3671,
COLON (STOMA) W/ POLY (SNARE),6400064,CDM,750,RC,44394,HCPCS,Outpatient,,,3262,2772.7,,2648.74,81.2,,,percent of total billed charges,81.2% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,1043.84,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,2479.12,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,1075.16,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,2935.8,90,,,percent of total billed charges,90% of total billed charges,2935.8,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2890.13,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2968.42,91,,,percent of total billed charges,91% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,1096.03,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,3001.04,92,,,percent of total billed charges,92% of total billed charges,548.4,3671,
SIGMOIDOSCOPY,6400005,CDM,750,RC,45330,HCPCS,Outpatient,,,1008,856.8,,818.5,81.2,,,percent of total billed charges,81.2% of total billed charges,329.01,32.64,,,percent of total billed charges,32.64% of total billed charges,745.92,74,,,percent of total billed charges,74% of total billed charges,745.92,74,,,percent of total billed charges,74% of total billed charges,322.56,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,322.56,32,,,percent of total billed charges,32% of total billed charges,715.68,71,,,percent of total billed charges,71% of total billed charges,715.68,71,,,percent of total billed charges,71% of total billed charges,675.36,67,,,percent of total billed charges,67% of total billed charges,675.36,67,,,percent of total billed charges,67% of total billed charges,715.68,71,,,percent of total billed charges,71% of total billed charges,766.08,76,,,percent of total billed charges,76% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,332.24,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,907.2,90,,,percent of total billed charges,90% of total billed charges,907.2,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,893.09,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,322.56,32,,,percent of total billed charges,32% of total billed charges,806.4,80,,,percent of total billed charges,80% of total billed charges,806.4,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,917.28,91,,,percent of total billed charges,91% of total billed charges,329.01,32.64,,,percent of total billed charges,32.64% of total billed charges,322.56,32,,,percent of total billed charges,32% of total billed charges,338.69,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,322.56,32,,,percent of total billed charges,32% of total billed charges,322.56,32,,,percent of total billed charges,32% of total billed charges,927.36,92,,,percent of total billed charges,92% of total billed charges,322.56,927.36,
SIGMOIDOSCOPY WITH BX,6400017,CDM,750,RC,45331,HCPCS,Outpatient,,,1274,1082.9,,1034.49,81.2,,,percent of total billed charges,81.2% of total billed charges,415.83,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,407.68,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,407.68,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,968.24,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,419.91,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,1146.6,90,,,percent of total billed charges,90% of total billed charges,1146.6,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,1128.76,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,407.68,32,,,percent of total billed charges,32% of total billed charges,1019.2,80,,,percent of total billed charges,80% of total billed charges,1019.2,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,1159.34,91,,,percent of total billed charges,91% of total billed charges,415.83,32.64,,,percent of total billed charges,32.64% of total billed charges,407.68,32,,,percent of total billed charges,32% of total billed charges,428.06,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,407.68,32,,,percent of total billed charges,32% of total billed charges,407.68,32,,,percent of total billed charges,32% of total billed charges,1172.08,92,,,percent of total billed charges,92% of total billed charges,407.68,3671,
SIGMOIDOSCOPY W/ CONTROL BLEEDING,6400059,CDM,750,RC,45334,HCPCS,Outpatient,,,1524,1295.4,,1237.49,81.2,,,percent of total billed charges,81.2% of total billed charges,497.43,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,487.68,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,487.68,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,1158.24,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,502.31,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,1371.6,90,,,percent of total billed charges,90% of total billed charges,1371.6,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,1350.26,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,487.68,32,,,percent of total billed charges,32% of total billed charges,1219.2,80,,,percent of total billed charges,80% of total billed charges,1219.2,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,1386.84,91,,,percent of total billed charges,91% of total billed charges,497.43,32.64,,,percent of total billed charges,32.64% of total billed charges,487.68,32,,,percent of total billed charges,32% of total billed charges,512.06,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,487.68,32,,,percent of total billed charges,32% of total billed charges,487.68,32,,,percent of total billed charges,32% of total billed charges,1402.08,92,,,percent of total billed charges,92% of total billed charges,487.68,3671,
SIGMOIDOSCOPY W/ POLYPECTOMY (SNARE),6400026,CDM,750,RC,45338,HCPCS,Outpatient,,,1524,1295.4,,1237.49,81.2,,,percent of total billed charges,81.2% of total billed charges,497.43,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,487.68,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,487.68,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,1158.24,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,502.31,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,1371.6,90,,,percent of total billed charges,90% of total billed charges,1371.6,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,1350.26,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,487.68,32,,,percent of total billed charges,32% of total billed charges,1219.2,80,,,percent of total billed charges,80% of total billed charges,1219.2,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,1386.84,91,,,percent of total billed charges,91% of total billed charges,497.43,32.64,,,percent of total billed charges,32.64% of total billed charges,487.68,32,,,percent of total billed charges,32% of total billed charges,512.06,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,487.68,32,,,percent of total billed charges,32% of total billed charges,487.68,32,,,percent of total billed charges,32% of total billed charges,1402.08,92,,,percent of total billed charges,92% of total billed charges,487.68,3671,
SIGMOIDOSCOPY W/ ABLATION,6400066,CDM,750,RC,45346,HCPCS,Outpatient,,,1524,1295.4,,1237.49,81.2,,,percent of total billed charges,81.2% of total billed charges,497.43,32.64,,,percent of total billed charges,32.64% of total billed charges,1127.76,74,,,percent of total billed charges,74% of total billed charges,1127.76,74,,,percent of total billed charges,74% of total billed charges,487.68,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,487.68,32,,,percent of total billed charges,32% of total billed charges,1082.04,71,,,percent of total billed charges,71% of total billed charges,1082.04,71,,,percent of total billed charges,71% of total billed charges,1021.08,67,,,percent of total billed charges,67% of total billed charges,1021.08,67,,,percent of total billed charges,67% of total billed charges,1082.04,71,,,percent of total billed charges,71% of total billed charges,1158.24,76,,,percent of total billed charges,76% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,502.31,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,1371.6,90,,,percent of total billed charges,90% of total billed charges,1371.6,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,1350.26,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,487.68,32,,,percent of total billed charges,32% of total billed charges,1219.2,80,,,percent of total billed charges,80% of total billed charges,1219.2,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,1386.84,91,,,percent of total billed charges,91% of total billed charges,497.43,32.64,,,percent of total billed charges,32.64% of total billed charges,487.68,32,,,percent of total billed charges,32% of total billed charges,512.06,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,487.68,32,,,percent of total billed charges,32% of total billed charges,487.68,32,,,percent of total billed charges,32% of total billed charges,1402.08,92,,,percent of total billed charges,92% of total billed charges,487.68,1402.08,
COLONOSCOPY,6400003,CDM,750,RC,45378,HCPCS,Outpatient,,,2305,1959.25,,1871.66,81.2,,,percent of total billed charges,81.2% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,737.6,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,737.6,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,1751.8,100,,,Fee Schedule,pays based on grouper fee Schedule,,,,,Other,Not Separately reimbursable,759.73,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,2074.5,90,,,percent of total billed charges,90% of total billed charges,2074.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,2042.23,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,737.6,32,,,percent of total billed charges,32% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,2097.55,91,,,percent of total billed charges,91% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,774.48,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,737.6,32,,,percent of total billed charges,32% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,2120.6,92,,,percent of total billed charges,92% of total billed charges,737.6,4917,
COLONOSCOPY W/ BX/POLY (COLD FORCEP),6400006,CDM,750,RC,45380,HCPCS,Outpatient,,,3262,2772.7,,2648.74,81.2,,,percent of total billed charges,81.2% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1043.84,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,1043.84,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,2479.12,100,,,Fee Schedule,pays based on grouper fee Schedule,,,,,Other,Not Separately reimbursable,1075.16,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,2935.8,90,,,percent of total billed charges,90% of total billed charges,2935.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,2890.13,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,1043.84,32,,,percent of total billed charges,32% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,2968.42,91,,,percent of total billed charges,91% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,1096.03,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,1043.84,32,,,percent of total billed charges,32% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,3001.04,92,,,percent of total billed charges,92% of total billed charges,1043.84,4917,
COLONOSCOPY W/ SUBMUCOUS INJECTION,6400061,CDM,750,RC,45381,HCPCS,Outpatient,,,3262,2772.7,,2648.74,81.2,,,percent of total billed charges,81.2% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1043.84,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,2479.12,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,1075.16,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,2935.8,90,,,percent of total billed charges,90% of total billed charges,2935.8,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2890.13,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2968.42,91,,,percent of total billed charges,91% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,1096.03,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,3001.04,92,,,percent of total billed charges,92% of total billed charges,548.4,4917,
COLONOSCOPY W/ POLYPECTOMY (SNARE),6400023,CDM,750,RC,45385,HCPCS,Outpatient,,,3488,2964.8,,2832.26,81.2,,,percent of total billed charges,81.2% of total billed charges,1138.48,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1116.16,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1116.16,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,2650.88,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,1149.64,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,3139.2,90,,,percent of total billed charges,90% of total billed charges,3139.2,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,3090.37,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1116.16,32,,,percent of total billed charges,32% of total billed charges,2790.4,80,,,percent of total billed charges,80% of total billed charges,2790.4,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,3174.08,91,,,percent of total billed charges,91% of total billed charges,1138.48,32.64,,,percent of total billed charges,32.64% of total billed charges,1116.16,32,,,percent of total billed charges,32% of total billed charges,1171.97,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1116.16,32,,,percent of total billed charges,32% of total billed charges,1116.16,32,,,percent of total billed charges,32% of total billed charges,3208.96,92,,,percent of total billed charges,92% of total billed charges,548.4,4917,
COLONOSCOPY W/ TRANS BALLOON DILATION,6400069,CDM,750,RC,45386,HCPCS,Outpatient,,,3262,2772.7,,2648.74,81.2,,,percent of total billed charges,81.2% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,1043.84,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,2479.12,100,,,Fee Schedule,pays based on grouper fee Schedule,564.86,103,,,Fee Schedule,pays based on EAPG rates,1075.16,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,2935.8,90,,,percent of total billed charges,90% of total billed charges,2935.8,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2890.13,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2968.42,91,,,percent of total billed charges,91% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,1096.03,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,3001.04,92,,,percent of total billed charges,92% of total billed charges,548.4,4917,
COLONOSCOPY DECOMPRESSION,6400068,CDM,750,RC,45393,HCPCS,Outpatient,,,3262,2772.7,,2648.74,81.2,,,percent of total billed charges,81.2% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,2413.88,74,,,percent of total billed charges,74% of total billed charges,2413.88,74,,,percent of total billed charges,74% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,2316.02,71,,,percent of total billed charges,71% of total billed charges,2316.02,71,,,percent of total billed charges,71% of total billed charges,2185.54,67,,,percent of total billed charges,67% of total billed charges,2185.54,67,,,percent of total billed charges,67% of total billed charges,2316.02,71,,,percent of total billed charges,71% of total billed charges,2479.12,76,,,percent of total billed charges,76% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1075.16,32.96,,,percent of total billed charges,32.96% of total billed charges,575.82,105,,,Fee Schedule,pays based on EAPG rates,2935.8,90,,,percent of total billed charges,90% of total billed charges,2935.8,90,,,percent of total billed charges,90% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2890.13,88.6,,,percent of total billed charges,88.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,2609.6,80,,,percent of total billed charges,80% of total billed charges,548.4,100,,,Fee Schedule,pays based on EAPG rates,2968.42,91,,,percent of total billed charges,91% of total billed charges,1064.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,1096.03,33.6,,,percent of total billed charges,33.6% of total billed charges,564.86,103,,,Fee Schedule,pays based on EAPG rates,1043.84,32,,,percent of total billed charges,32% of total billed charges,1043.84,32,,,percent of total billed charges,32% of total billed charges,3001.04,92,,,percent of total billed charges,92% of total billed charges,548.4,3001.04,
REMOVAL OF FECAL IMPACTION/FOREIGN BODY,6400049,CDM,750,RC,45915,HCPCS,Outpatient,,,735,624.75,,596.82,81.2,,,percent of total billed charges,81.2% of total billed charges,239.9,32.64,,,percent of total billed charges,32.64% of total billed charges,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,3671,100,,,Fee Schedule,Pays based on grouper fee Schedule,235.2,32,,,percent of total billed charges,32% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,235.2,32,,,percent of total billed charges,32% of total billed charges,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3304,100,,,Fee Schedule,pays based on grouper fee Schedule,3488,100,,,Fee Schedule,pays based on grouper fee Schedule,558.6,100,,,Fee Schedule,pays based on grouper fee Schedule,690,103,,,Fee Schedule,pays based on EAPG rates,242.26,32.96,,,percent of total billed charges,32.96% of total billed charges,703.39,105,,,Fee Schedule,pays based on EAPG rates,661.5,90,,,percent of total billed charges,90% of total billed charges,661.5,90,,,percent of total billed charges,90% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,651.21,88.6,,,percent of total billed charges,88.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,235.2,32,,,percent of total billed charges,32% of total billed charges,588,80,,,percent of total billed charges,80% of total billed charges,588,80,,,percent of total billed charges,80% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,668.85,91,,,percent of total billed charges,91% of total billed charges,239.9,32.64,,,percent of total billed charges,32.64% of total billed charges,235.2,32,,,percent of total billed charges,32% of total billed charges,246.96,33.6,,,percent of total billed charges,33.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,235.2,32,,,percent of total billed charges,32% of total billed charges,235.2,32,,,percent of total billed charges,32% of total billed charges,676.2,92,,,percent of total billed charges,92% of total billed charges,235.2,3671,
ENDO CAPSULE,6400047,CDM,750,RC,91110,HCPCS,Outpatient,,,1594,1354.9,,1294.33,81.2,,,percent of total billed charges,81.2% of total billed charges,520.28,32.64,,,percent of total billed charges,32.64% of total billed charges,1179.56,74,,,percent of total billed charges,74% of total billed charges,1179.56,74,,,percent of total billed charges,74% of total billed charges,510.08,32,,,percent of total billed charges,32% of total billed charges,1250.86,103,,,Fee Schedule,pays based on EAPG rates,510.08,32,,,percent of total billed charges,32% of total billed charges,1131.74,71,,,percent of total billed charges,71% of total billed charges,1131.74,71,,,percent of total billed charges,71% of total billed charges,1067.98,67,,,percent of total billed charges,67% of total billed charges,1067.98,67,,,percent of total billed charges,67% of total billed charges,1131.74,71,,,percent of total billed charges,71% of total billed charges,1211.44,76,,,percent of total billed charges,76% of total billed charges,1250.86,103,,,Fee Schedule,pays based on EAPG rates,525.38,32.96,,,percent of total billed charges,32.96% of total billed charges,1275.14,105,,,Fee Schedule,pays based on EAPG rates,1434.6,90,,,percent of total billed charges,90% of total billed charges,1434.6,90,,,percent of total billed charges,90% of total billed charges,1214.42,100,,,Fee Schedule,pays based on EAPG rates,1412.28,88.6,,,percent of total billed charges,88.6% of total billed charges,1250.86,103,,,Fee Schedule,pays based on EAPG rates,510.08,32,,,percent of total billed charges,32% of total billed charges,1275.2,80,,,percent of total billed charges,80% of total billed charges,1275.2,80,,,percent of total billed charges,80% of total billed charges,1214.42,100,,,Fee Schedule,pays based on EAPG rates,1450.54,91,,,percent of total billed charges,91% of total billed charges,520.28,32.64,,,percent of total billed charges,32.64% of total billed charges,510.08,32,,,percent of total billed charges,32% of total billed charges,535.58,33.6,,,percent of total billed charges,33.6% of total billed charges,1250.86,103,,,Fee Schedule,pays based on EAPG rates,510.08,32,,,percent of total billed charges,32% of total billed charges,510.08,32,,,percent of total billed charges,32% of total billed charges,1466.48,92,,,percent of total billed charges,92% of total billed charges,510.08,1466.48,
GASTROINTESTINAL TRANSIT & PRESSURE STOM,6400056,CDM,750,RC,91112,HCPCS,Outpatient,,,1096,931.6,,889.95,81.2,,,percent of total billed charges,81.2% of total billed charges,357.73,32.64,,,percent of total billed charges,32.64% of total billed charges,811.04,74,,,percent of total billed charges,74% of total billed charges,811.04,74,,,percent of total billed charges,74% of total billed charges,350.72,32,,,percent of total billed charges,32% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,350.72,32,,,percent of total billed charges,32% of total billed charges,778.16,71,,,percent of total billed charges,71% of total billed charges,778.16,71,,,percent of total billed charges,71% of total billed charges,734.32,67,,,percent of total billed charges,67% of total billed charges,734.32,67,,,percent of total billed charges,67% of total billed charges,778.16,71,,,percent of total billed charges,71% of total billed charges,832.96,76,,,percent of total billed charges,76% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,361.24,32.96,,,percent of total billed charges,32.96% of total billed charges,193.67,105,,,Fee Schedule,pays based on EAPG rates,986.4,90,,,percent of total billed charges,90% of total billed charges,986.4,90,,,percent of total billed charges,90% of total billed charges,184.45,100,,,Fee Schedule,pays based on EAPG rates,971.06,88.6,,,percent of total billed charges,88.6% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,350.72,32,,,percent of total billed charges,32% of total billed charges,876.8,80,,,percent of total billed charges,80% of total billed charges,876.8,80,,,percent of total billed charges,80% of total billed charges,184.45,100,,,Fee Schedule,pays based on EAPG rates,997.36,91,,,percent of total billed charges,91% of total billed charges,357.73,32.64,,,percent of total billed charges,32.64% of total billed charges,350.72,32,,,percent of total billed charges,32% of total billed charges,368.26,33.6,,,percent of total billed charges,33.6% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,350.72,32,,,percent of total billed charges,32% of total billed charges,350.72,32,,,percent of total billed charges,32% of total billed charges,1008.32,92,,,percent of total billed charges,92% of total billed charges,184.45,1008.32,
SIGMOIDOSCOPY (MC) SCREENING,6400014,CDM,750,RC,G0104,HCPCS,Outpatient,,,556,472.6,,451.47,81.2,,,percent of total billed charges,81.2% of total billed charges,181.48,32.64,,,percent of total billed charges,32.64% of total billed charges,411.44,74,,,percent of total billed charges,74% of total billed charges,411.44,74,,,percent of total billed charges,74% of total billed charges,177.92,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,177.92,32,,,percent of total billed charges,32% of total billed charges,394.76,71,,,percent of total billed charges,71% of total billed charges,394.76,71,,,percent of total billed charges,71% of total billed charges,372.52,67,,,percent of total billed charges,67% of total billed charges,372.52,67,,,percent of total billed charges,67% of total billed charges,394.76,71,,,percent of total billed charges,71% of total billed charges,422.56,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,183.26,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,500.4,90,,,percent of total billed charges,90% of total billed charges,500.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,492.62,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,177.92,32,,,percent of total billed charges,32% of total billed charges,444.8,80,,,percent of total billed charges,80% of total billed charges,444.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,505.96,91,,,percent of total billed charges,91% of total billed charges,181.48,32.64,,,percent of total billed charges,32.64% of total billed charges,177.92,32,,,percent of total billed charges,32% of total billed charges,186.82,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,177.92,32,,,percent of total billed charges,32% of total billed charges,177.92,32,,,percent of total billed charges,32% of total billed charges,511.52,92,,,percent of total billed charges,92% of total billed charges,177.92,511.52,
COLONOSCOPY HIGH RISK PT ONLY,6400015,CDM,750,RC,G0105,HCPCS,Outpatient,,,2305,1959.25,,1871.66,81.2,,,percent of total billed charges,81.2% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,737.6,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,737.6,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,1751.8,100,,,Fee Schedule,pays based on grouper fee Schedule,,,,,Other,Not Separately reimbursable,759.73,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,2074.5,90,,,percent of total billed charges,90% of total billed charges,2074.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,2042.23,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,737.6,32,,,percent of total billed charges,32% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,2097.55,91,,,percent of total billed charges,91% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,774.48,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,737.6,32,,,percent of total billed charges,32% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,2120.6,92,,,percent of total billed charges,92% of total billed charges,737.6,4917,
COLONOSCOPY NON HIGH RISK PT ONLY,6400050,CDM,750,RC,G0121,HCPCS,Outpatient,,,2305,1959.25,,1871.66,81.2,,,percent of total billed charges,81.2% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,4917,100,,,Fee Schedule,Pays based on grouper fee Schedule,737.6,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,737.6,32,,,percent of total billed charges,32% of total billed charges,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4425,100,,,Fee Schedule,pays based on grouper fee Schedule,4671,100,,,Fee Schedule,pays based on grouper fee Schedule,1751.8,100,,,Fee Schedule,pays based on grouper fee Schedule,,,,,Other,Not Separately reimbursable,759.73,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,2074.5,90,,,percent of total billed charges,90% of total billed charges,2074.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,2042.23,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,737.6,32,,,percent of total billed charges,32% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,1844,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,2097.55,91,,,percent of total billed charges,91% of total billed charges,752.35,32.64,,,percent of total billed charges,32.64% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,774.48,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,737.6,32,,,percent of total billed charges,32% of total billed charges,737.6,32,,,percent of total billed charges,32% of total billed charges,2120.6,92,,,percent of total billed charges,92% of total billed charges,737.6,4917,
REPLACEMENT PEG TUBE W/O EGD,6400044,CDM,750,RC,,,Outpatient,,,438,372.3,,355.66,81.2,,,percent of total billed charges,81.2% of total billed charges,142.96,32.64,,,percent of total billed charges,32.64% of total billed charges,324.12,74,,,percent of total billed charges,74% of total billed charges,324.12,74,,,percent of total billed charges,74% of total billed charges,140.16,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,140.16,32,,,percent of total billed charges,32% of total billed charges,310.98,71,,,percent of total billed charges,71% of total billed charges,310.98,71,,,percent of total billed charges,71% of total billed charges,293.46,67,,,percent of total billed charges,67% of total billed charges,293.46,67,,,percent of total billed charges,67% of total billed charges,310.98,71,,,percent of total billed charges,71% of total billed charges,332.88,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,144.36,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,394.2,90,,,percent of total billed charges,90% of total billed charges,394.2,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,388.07,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,140.16,32,,,percent of total billed charges,32% of total billed charges,350.4,80,,,percent of total billed charges,80% of total billed charges,350.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,398.58,91,,,percent of total billed charges,91% of total billed charges,142.96,32.64,,,percent of total billed charges,32.64% of total billed charges,140.16,32,,,percent of total billed charges,32% of total billed charges,147.17,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,140.16,32,,,percent of total billed charges,32% of total billed charges,140.16,32,,,percent of total billed charges,32% of total billed charges,402.96,92,,,percent of total billed charges,92% of total billed charges,140.16,402.96,
COLONOSCOPY INCOMPLETE,6400054,CDM,750,RC,,,Outpatient,,,1198,1018.3,,972.78,81.2,,,percent of total billed charges,81.2% of total billed charges,391.03,32.64,,,percent of total billed charges,32.64% of total billed charges,886.52,74,,,percent of total billed charges,74% of total billed charges,886.52,74,,,percent of total billed charges,74% of total billed charges,383.36,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,383.36,32,,,percent of total billed charges,32% of total billed charges,850.58,71,,,percent of total billed charges,71% of total billed charges,850.58,71,,,percent of total billed charges,71% of total billed charges,802.66,67,,,percent of total billed charges,67% of total billed charges,802.66,67,,,percent of total billed charges,67% of total billed charges,850.58,71,,,percent of total billed charges,71% of total billed charges,910.48,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,394.86,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1078.2,90,,,percent of total billed charges,90% of total billed charges,1078.2,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1061.43,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,383.36,32,,,percent of total billed charges,32% of total billed charges,958.4,80,,,percent of total billed charges,80% of total billed charges,958.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1090.18,91,,,percent of total billed charges,91% of total billed charges,391.03,32.64,,,percent of total billed charges,32.64% of total billed charges,383.36,32,,,percent of total billed charges,32% of total billed charges,402.53,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,383.36,32,,,percent of total billed charges,32% of total billed charges,383.36,32,,,percent of total billed charges,32% of total billed charges,1102.16,92,,,percent of total billed charges,92% of total billed charges,383.36,1102.16,
INCISION & DRAIN ABCESS;SIMPLE/SINGLE,1000045,CDM,450,RC,10060,HCPCS,Outpatient,,,291,247.35,,236.29,81.2,,,percent of total billed charges,81.2% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,221.16,76,,,percent of total billed charges,76% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,95.91,32.96,,,percent of total billed charges,32.96% of total billed charges,109.18,105,,,Fee Schedule,pays based on EAPG rates,261.9,90,,,percent of total billed charges,90% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,257.83,88.6,,,percent of total billed charges,88.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,264.81,91,,,percent of total billed charges,91% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,97.78,33.6,,,percent of total billed charges,33.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,267.72,92,,,percent of total billed charges,92% of total billed charges,93.12,267.72,
INCISION & DRAIN ABSCESS;COMPLICATE/MULT,1000046,CDM,450,RC,10061,HCPCS,Outpatient,,,351,298.35,,285.01,81.2,,,percent of total billed charges,81.2% of total billed charges,114.57,32.64,,,percent of total billed charges,32.64% of total billed charges,259.74,74,,,percent of total billed charges,74% of total billed charges,259.74,74,,,percent of total billed charges,74% of total billed charges,112.32,32,,,percent of total billed charges,32% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,112.32,32,,,percent of total billed charges,32% of total billed charges,249.21,71,,,percent of total billed charges,71% of total billed charges,249.21,71,,,percent of total billed charges,71% of total billed charges,235.17,67,,,percent of total billed charges,67% of total billed charges,235.17,67,,,percent of total billed charges,67% of total billed charges,249.21,71,,,percent of total billed charges,71% of total billed charges,266.76,76,,,percent of total billed charges,76% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,115.69,32.96,,,percent of total billed charges,32.96% of total billed charges,109.18,105,,,Fee Schedule,pays based on EAPG rates,315.9,90,,,percent of total billed charges,90% of total billed charges,315.9,90,,,percent of total billed charges,90% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,310.99,88.6,,,percent of total billed charges,88.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,112.32,32,,,percent of total billed charges,32% of total billed charges,280.8,80,,,percent of total billed charges,80% of total billed charges,280.8,80,,,percent of total billed charges,80% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,319.41,91,,,percent of total billed charges,91% of total billed charges,114.57,32.64,,,percent of total billed charges,32.64% of total billed charges,112.32,32,,,percent of total billed charges,32% of total billed charges,117.94,33.6,,,percent of total billed charges,33.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,112.32,32,,,percent of total billed charges,32% of total billed charges,112.32,32,,,percent of total billed charges,32% of total billed charges,322.92,92,,,percent of total billed charges,92% of total billed charges,103.98,322.92,
INCISION & DRAIN PILONIDAL CYST/SIMPLE,1000047,CDM,450,RC,10080,HCPCS,Outpatient,,,303,257.55,,246.04,81.2,,,percent of total billed charges,81.2% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,230.28,76,,,percent of total billed charges,76% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,99.87,32.96,,,percent of total billed charges,32.96% of total billed charges,109.18,105,,,Fee Schedule,pays based on EAPG rates,272.7,90,,,percent of total billed charges,90% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,268.46,88.6,,,percent of total billed charges,88.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,275.73,91,,,percent of total billed charges,91% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,101.81,33.6,,,percent of total billed charges,33.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,278.76,92,,,percent of total billed charges,92% of total billed charges,96.96,278.76,
INCISION & DRAIN PILONIDAL CYST/COMPLICA,1000048,CDM,450,RC,10081,HCPCS,Outpatient,,,414,351.9,,336.17,81.2,,,percent of total billed charges,81.2% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,314.64,76,,,percent of total billed charges,76% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,136.45,32.96,,,percent of total billed charges,32.96% of total billed charges,378.8,105,,,Fee Schedule,pays based on EAPG rates,372.6,90,,,percent of total billed charges,90% of total billed charges,372.6,90,,,percent of total billed charges,90% of total billed charges,360.76,100,,,Fee Schedule,pays based on EAPG rates,366.8,88.6,,,percent of total billed charges,88.6% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,360.76,100,,,Fee Schedule,pays based on EAPG rates,376.74,91,,,percent of total billed charges,91% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,139.1,33.6,,,percent of total billed charges,33.6% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,380.88,92,,,percent of total billed charges,92% of total billed charges,132.48,380.88,
INCISION & REMOVE FB/SUBCUT TISS/SIMPLE,1000049,CDM,450,RC,10120,HCPCS,Outpatient,,,201,170.85,,163.21,81.2,,,percent of total billed charges,81.2% of total billed charges,65.61,32.64,,,percent of total billed charges,32.64% of total billed charges,148.74,74,,,percent of total billed charges,74% of total billed charges,148.74,74,,,percent of total billed charges,74% of total billed charges,64.32,32,,,percent of total billed charges,32% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,64.32,32,,,percent of total billed charges,32% of total billed charges,142.71,71,,,percent of total billed charges,71% of total billed charges,142.71,71,,,percent of total billed charges,71% of total billed charges,134.67,67,,,percent of total billed charges,67% of total billed charges,134.67,67,,,percent of total billed charges,67% of total billed charges,142.71,71,,,percent of total billed charges,71% of total billed charges,152.76,76,,,percent of total billed charges,76% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,66.25,32.96,,,percent of total billed charges,32.96% of total billed charges,109.18,105,,,Fee Schedule,pays based on EAPG rates,180.9,90,,,percent of total billed charges,90% of total billed charges,180.9,90,,,percent of total billed charges,90% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,178.09,88.6,,,percent of total billed charges,88.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,64.32,32,,,percent of total billed charges,32% of total billed charges,160.8,80,,,percent of total billed charges,80% of total billed charges,160.8,80,,,percent of total billed charges,80% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,182.91,91,,,percent of total billed charges,91% of total billed charges,65.61,32.64,,,percent of total billed charges,32.64% of total billed charges,64.32,32,,,percent of total billed charges,32% of total billed charges,67.54,33.6,,,percent of total billed charges,33.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,64.32,32,,,percent of total billed charges,32% of total billed charges,64.32,32,,,percent of total billed charges,32% of total billed charges,184.92,92,,,percent of total billed charges,92% of total billed charges,64.32,184.92,
INCISION & REMOVE FB/SUBCUT TISS/COMPL,1000050,CDM,450,RC,10121,HCPCS,Outpatient,,,428,363.8,,347.54,81.2,,,percent of total billed charges,81.2% of total billed charges,139.7,32.64,,,percent of total billed charges,32.64% of total billed charges,316.72,74,,,percent of total billed charges,74% of total billed charges,316.72,74,,,percent of total billed charges,74% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,286.76,67,,,percent of total billed charges,67% of total billed charges,286.76,67,,,percent of total billed charges,67% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,325.28,76,,,percent of total billed charges,76% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,141.07,32.96,,,percent of total billed charges,32.96% of total billed charges,685.99,105,,,Fee Schedule,pays based on EAPG rates,385.2,90,,,percent of total billed charges,90% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,379.21,88.6,,,percent of total billed charges,88.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,342.4,80,,,percent of total billed charges,80% of total billed charges,342.4,80,,,percent of total billed charges,80% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,389.48,91,,,percent of total billed charges,91% of total billed charges,139.7,32.64,,,percent of total billed charges,32.64% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,143.81,33.6,,,percent of total billed charges,33.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,393.76,92,,,percent of total billed charges,92% of total billed charges,136.96,685.99,
"INCISION & DRAIN HEMATOMA,SEROMA/FLUID C",1000051,CDM,450,RC,10140,HCPCS,Outpatient,,,337,286.45,,273.64,81.2,,,percent of total billed charges,81.2% of total billed charges,110,32.64,,,percent of total billed charges,32.64% of total billed charges,249.38,74,,,percent of total billed charges,74% of total billed charges,249.38,74,,,percent of total billed charges,74% of total billed charges,107.84,32,,,percent of total billed charges,32% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,107.84,32,,,percent of total billed charges,32% of total billed charges,239.27,71,,,percent of total billed charges,71% of total billed charges,239.27,71,,,percent of total billed charges,71% of total billed charges,225.79,67,,,percent of total billed charges,67% of total billed charges,225.79,67,,,percent of total billed charges,67% of total billed charges,239.27,71,,,percent of total billed charges,71% of total billed charges,256.12,76,,,percent of total billed charges,76% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,111.08,32.96,,,percent of total billed charges,32.96% of total billed charges,378.8,105,,,Fee Schedule,pays based on EAPG rates,303.3,90,,,percent of total billed charges,90% of total billed charges,303.3,90,,,percent of total billed charges,90% of total billed charges,360.76,100,,,Fee Schedule,pays based on EAPG rates,298.58,88.6,,,percent of total billed charges,88.6% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,107.84,32,,,percent of total billed charges,32% of total billed charges,269.6,80,,,percent of total billed charges,80% of total billed charges,269.6,80,,,percent of total billed charges,80% of total billed charges,360.76,100,,,Fee Schedule,pays based on EAPG rates,306.67,91,,,percent of total billed charges,91% of total billed charges,110,32.64,,,percent of total billed charges,32.64% of total billed charges,107.84,32,,,percent of total billed charges,32% of total billed charges,113.23,33.6,,,percent of total billed charges,33.6% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,107.84,32,,,percent of total billed charges,32% of total billed charges,107.84,32,,,percent of total billed charges,32% of total billed charges,310.04,92,,,percent of total billed charges,92% of total billed charges,107.84,378.8,
"PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA",1000201,CDM,450,RC,10160,HCPCS,Outpatient,,,209,177.65,,169.71,81.2,,,percent of total billed charges,81.2% of total billed charges,68.22,32.64,,,percent of total billed charges,32.64% of total billed charges,154.66,74,,,percent of total billed charges,74% of total billed charges,154.66,74,,,percent of total billed charges,74% of total billed charges,66.88,32,,,percent of total billed charges,32% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,66.88,32,,,percent of total billed charges,32% of total billed charges,148.39,71,,,percent of total billed charges,71% of total billed charges,148.39,71,,,percent of total billed charges,71% of total billed charges,140.03,67,,,percent of total billed charges,67% of total billed charges,140.03,67,,,percent of total billed charges,67% of total billed charges,148.39,71,,,percent of total billed charges,71% of total billed charges,158.84,76,,,percent of total billed charges,76% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,68.89,32.96,,,percent of total billed charges,32.96% of total billed charges,109.18,105,,,Fee Schedule,pays based on EAPG rates,188.1,90,,,percent of total billed charges,90% of total billed charges,188.1,90,,,percent of total billed charges,90% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,185.17,88.6,,,percent of total billed charges,88.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,66.88,32,,,percent of total billed charges,32% of total billed charges,167.2,80,,,percent of total billed charges,80% of total billed charges,167.2,80,,,percent of total billed charges,80% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,190.19,91,,,percent of total billed charges,91% of total billed charges,68.22,32.64,,,percent of total billed charges,32.64% of total billed charges,66.88,32,,,percent of total billed charges,32% of total billed charges,70.22,33.6,,,percent of total billed charges,33.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,66.88,32,,,percent of total billed charges,32% of total billed charges,66.88,32,,,percent of total billed charges,32% of total billed charges,192.28,92,,,percent of total billed charges,92% of total billed charges,66.88,192.28,
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN,1000222,CDM,450,RC,11010,HCPCS,Outpatient,,,705,599.25,,572.46,81.2,,,percent of total billed charges,81.2% of total billed charges,230.11,32.64,,,percent of total billed charges,32.64% of total billed charges,521.7,74,,,percent of total billed charges,74% of total billed charges,521.7,74,,,percent of total billed charges,74% of total billed charges,225.6,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,225.6,32,,,percent of total billed charges,32% of total billed charges,500.55,71,,,percent of total billed charges,71% of total billed charges,500.55,71,,,percent of total billed charges,71% of total billed charges,472.35,67,,,percent of total billed charges,67% of total billed charges,472.35,67,,,percent of total billed charges,67% of total billed charges,500.55,71,,,percent of total billed charges,71% of total billed charges,535.8,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,232.37,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,634.5,90,,,percent of total billed charges,90% of total billed charges,634.5,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,624.63,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,225.6,32,,,percent of total billed charges,32% of total billed charges,564,80,,,percent of total billed charges,80% of total billed charges,564,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,641.55,91,,,percent of total billed charges,91% of total billed charges,230.11,32.64,,,percent of total billed charges,32.64% of total billed charges,225.6,32,,,percent of total billed charges,32% of total billed charges,236.88,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,225.6,32,,,percent of total billed charges,32% of total billed charges,225.6,32,,,percent of total billed charges,32% of total billed charges,648.6,92,,,percent of total billed charges,92% of total billed charges,147.31,648.6,
DEBRI;SKIN & SUBCUT TISSUE 1ST 20 SQ CM,1000052,CDM,450,RC,11042,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,42.56,154.68,
"PUNCH BIOPSY SKIN, SINGLE LESION",1000449,CDM,761,RC,11104,HCPCS,Outpatient,,,1180,1003,,958.16,81.2,,,percent of total billed charges,81.2% of total billed charges,385.15,32.64,,,percent of total billed charges,32.64% of total billed charges,873.2,74,,,percent of total billed charges,74% of total billed charges,873.2,74,,,percent of total billed charges,74% of total billed charges,377.6,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,377.6,32,,,percent of total billed charges,32% of total billed charges,837.8,71,,,percent of total billed charges,71% of total billed charges,837.8,71,,,percent of total billed charges,71% of total billed charges,790.6,67,,,percent of total billed charges,67% of total billed charges,790.6,67,,,percent of total billed charges,67% of total billed charges,837.8,71,,,percent of total billed charges,71% of total billed charges,896.8,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,388.93,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,1062,90,,,percent of total billed charges,90% of total billed charges,1062,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,1045.48,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,377.6,32,,,percent of total billed charges,32% of total billed charges,944,80,,,percent of total billed charges,80% of total billed charges,944,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,1073.8,91,,,percent of total billed charges,91% of total billed charges,385.15,32.64,,,percent of total billed charges,32.64% of total billed charges,377.6,32,,,percent of total billed charges,32% of total billed charges,396.48,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,377.6,32,,,percent of total billed charges,32% of total billed charges,377.6,32,,,percent of total billed charges,32% of total billed charges,1085.6,92,,,percent of total billed charges,92% of total billed charges,239.85,1085.6,
"PUNCH BIOPSY SKIN, ADDTL LESION",1000450,CDM,761,RC,11105,HCPCS,Outpatient,,,590,501.5,,479.08,81.2,,,percent of total billed charges,81.2% of total billed charges,192.58,32.64,,,percent of total billed charges,32.64% of total billed charges,436.6,74,,,percent of total billed charges,74% of total billed charges,436.6,74,,,percent of total billed charges,74% of total billed charges,188.8,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,188.8,32,,,percent of total billed charges,32% of total billed charges,418.9,71,,,percent of total billed charges,71% of total billed charges,418.9,71,,,percent of total billed charges,71% of total billed charges,395.3,67,,,percent of total billed charges,67% of total billed charges,395.3,67,,,percent of total billed charges,67% of total billed charges,418.9,71,,,percent of total billed charges,71% of total billed charges,448.4,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,194.46,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,531,90,,,percent of total billed charges,90% of total billed charges,531,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,522.74,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,188.8,32,,,percent of total billed charges,32% of total billed charges,472,80,,,percent of total billed charges,80% of total billed charges,472,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,536.9,91,,,percent of total billed charges,91% of total billed charges,192.58,32.64,,,percent of total billed charges,32.64% of total billed charges,188.8,32,,,percent of total billed charges,32% of total billed charges,198.24,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,188.8,32,,,percent of total billed charges,32% of total billed charges,188.8,32,,,percent of total billed charges,32% of total billed charges,542.8,92,,,percent of total billed charges,92% of total billed charges,188.8,542.8,
RMVL SKIN TAGS (FIRST 15),1000419,CDM,370,RC,11200,HCPCS,Outpatient,,,651,553.35,,528.61,81.2,,,percent of total billed charges,81.2% of total billed charges,212.49,32.64,,,percent of total billed charges,32.64% of total billed charges,481.74,74,,,percent of total billed charges,74% of total billed charges,481.74,74,,,percent of total billed charges,74% of total billed charges,208.32,32,,,percent of total billed charges,32% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,208.32,32,,,percent of total billed charges,32% of total billed charges,462.21,71,,,percent of total billed charges,71% of total billed charges,462.21,71,,,percent of total billed charges,71% of total billed charges,436.17,67,,,percent of total billed charges,67% of total billed charges,436.17,67,,,percent of total billed charges,67% of total billed charges,462.21,71,,,percent of total billed charges,71% of total billed charges,494.76,76,,,percent of total billed charges,76% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,214.57,32.96,,,percent of total billed charges,32.96% of total billed charges,109.18,105,,,Fee Schedule,pays based on EAPG rates,585.9,90,,,percent of total billed charges,90% of total billed charges,585.9,90,,,percent of total billed charges,90% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,576.79,88.6,,,percent of total billed charges,88.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,208.32,32,,,percent of total billed charges,32% of total billed charges,520.8,80,,,percent of total billed charges,80% of total billed charges,520.8,80,,,percent of total billed charges,80% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,592.41,91,,,percent of total billed charges,91% of total billed charges,212.49,32.64,,,percent of total billed charges,32.64% of total billed charges,208.32,32,,,percent of total billed charges,32% of total billed charges,218.74,33.6,,,percent of total billed charges,33.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,208.32,32,,,percent of total billed charges,32% of total billed charges,208.32,32,,,percent of total billed charges,32% of total billed charges,598.92,92,,,percent of total billed charges,92% of total billed charges,103.98,598.92,
"SHAVING OF EPIDERMAL/DERMAL LESION,<.5CM",1000221,CDM,450,RC,11300,HCPCS,Outpatient,,,87,73.95,,70.64,81.2,,,percent of total billed charges,81.2% of total billed charges,28.4,32.64,,,percent of total billed charges,32.64% of total billed charges,64.38,74,,,percent of total billed charges,74% of total billed charges,64.38,74,,,percent of total billed charges,74% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,58.29,67,,,percent of total billed charges,67% of total billed charges,58.29,67,,,percent of total billed charges,67% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,66.12,76,,,percent of total billed charges,76% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,28.68,32.96,,,percent of total billed charges,32.96% of total billed charges,109.18,105,,,Fee Schedule,pays based on EAPG rates,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,77.08,88.6,,,percent of total billed charges,88.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,69.6,80,,,percent of total billed charges,80% of total billed charges,69.6,80,,,percent of total billed charges,80% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,79.17,91,,,percent of total billed charges,91% of total billed charges,28.4,32.64,,,percent of total billed charges,32.64% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,29.23,33.6,,,percent of total billed charges,33.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,80.04,92,,,percent of total billed charges,92% of total billed charges,27.84,109.18,
EXC MALIGNANT LESION W/ MARGIN .5CM OR<,1000223,CDM,450,RC,11604,HCPCS,Outpatient,,,535,454.75,,434.42,81.2,,,percent of total billed charges,81.2% of total billed charges,174.62,32.64,,,percent of total billed charges,32.64% of total billed charges,395.9,74,,,percent of total billed charges,74% of total billed charges,395.9,74,,,percent of total billed charges,74% of total billed charges,171.2,32,,,percent of total billed charges,32% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,171.2,32,,,percent of total billed charges,32% of total billed charges,379.85,71,,,percent of total billed charges,71% of total billed charges,379.85,71,,,percent of total billed charges,71% of total billed charges,358.45,67,,,percent of total billed charges,67% of total billed charges,358.45,67,,,percent of total billed charges,67% of total billed charges,379.85,71,,,percent of total billed charges,71% of total billed charges,406.6,76,,,percent of total billed charges,76% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,176.34,32.96,,,percent of total billed charges,32.96% of total billed charges,685.99,105,,,Fee Schedule,pays based on EAPG rates,481.5,90,,,percent of total billed charges,90% of total billed charges,481.5,90,,,percent of total billed charges,90% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,474.01,88.6,,,percent of total billed charges,88.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,171.2,32,,,percent of total billed charges,32% of total billed charges,428,80,,,percent of total billed charges,80% of total billed charges,428,80,,,percent of total billed charges,80% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,486.85,91,,,percent of total billed charges,91% of total billed charges,174.62,32.64,,,percent of total billed charges,32.64% of total billed charges,171.2,32,,,percent of total billed charges,32% of total billed charges,179.76,33.6,,,percent of total billed charges,33.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,171.2,32,,,percent of total billed charges,32% of total billed charges,171.2,32,,,percent of total billed charges,32% of total billed charges,492.2,92,,,percent of total billed charges,92% of total billed charges,171.2,685.99,
DEBRIDEMENT OF NAIL(S) BY ANY METHOD 1-5,1000220,CDM,450,RC,11720,HCPCS,Outpatient,,,53,45.05,,43.04,81.2,,,percent of total billed charges,81.2% of total billed charges,17.3,32.64,,,percent of total billed charges,32.64% of total billed charges,39.22,74,,,percent of total billed charges,74% of total billed charges,39.22,74,,,percent of total billed charges,74% of total billed charges,16.96,32,,,percent of total billed charges,32% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,16.96,32,,,percent of total billed charges,32% of total billed charges,37.63,71,,,percent of total billed charges,71% of total billed charges,37.63,71,,,percent of total billed charges,71% of total billed charges,35.51,67,,,percent of total billed charges,67% of total billed charges,35.51,67,,,percent of total billed charges,67% of total billed charges,37.63,71,,,percent of total billed charges,71% of total billed charges,40.28,76,,,percent of total billed charges,76% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,17.47,32.96,,,percent of total billed charges,32.96% of total billed charges,30.84,105,,,Fee Schedule,pays based on EAPG rates,47.7,90,,,percent of total billed charges,90% of total billed charges,47.7,90,,,percent of total billed charges,90% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,46.96,88.6,,,percent of total billed charges,88.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,16.96,32,,,percent of total billed charges,32% of total billed charges,42.4,80,,,percent of total billed charges,80% of total billed charges,42.4,80,,,percent of total billed charges,80% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,48.23,91,,,percent of total billed charges,91% of total billed charges,17.3,32.64,,,percent of total billed charges,32.64% of total billed charges,16.96,32,,,percent of total billed charges,32% of total billed charges,17.81,33.6,,,percent of total billed charges,33.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,16.96,32,,,percent of total billed charges,32% of total billed charges,16.96,32,,,percent of total billed charges,32% of total billed charges,48.76,92,,,percent of total billed charges,92% of total billed charges,16.96,48.76,
AVULSION OF NAIL PLATE/PART/COMP SIM/SIN,1000053,CDM,450,RC,11730,HCPCS,Outpatient,,,185,157.25,,150.22,81.2,,,percent of total billed charges,81.2% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,140.6,76,,,percent of total billed charges,76% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,60.98,32.96,,,percent of total billed charges,32.96% of total billed charges,30.84,105,,,Fee Schedule,pays based on EAPG rates,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,163.91,88.6,,,percent of total billed charges,88.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,168.35,91,,,percent of total billed charges,91% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,62.16,33.6,,,percent of total billed charges,33.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,170.2,92,,,percent of total billed charges,92% of total billed charges,29.37,170.2,
AVUL NAIL PLATE/PART-COMP/SIMP EA ADD,1000054,CDM,450,RC,11732,HCPCS,Outpatient,,,97,82.45,,78.76,81.2,,,percent of total billed charges,81.2% of total billed charges,31.66,32.64,,,percent of total billed charges,32.64% of total billed charges,71.78,74,,,percent of total billed charges,74% of total billed charges,71.78,74,,,percent of total billed charges,74% of total billed charges,31.04,32,,,percent of total billed charges,32% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,31.04,32,,,percent of total billed charges,32% of total billed charges,68.87,71,,,percent of total billed charges,71% of total billed charges,68.87,71,,,percent of total billed charges,71% of total billed charges,64.99,67,,,percent of total billed charges,67% of total billed charges,64.99,67,,,percent of total billed charges,67% of total billed charges,68.87,71,,,percent of total billed charges,71% of total billed charges,73.72,76,,,percent of total billed charges,76% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,31.97,32.96,,,percent of total billed charges,32.96% of total billed charges,30.84,105,,,Fee Schedule,pays based on EAPG rates,87.3,90,,,percent of total billed charges,90% of total billed charges,87.3,90,,,percent of total billed charges,90% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,85.94,88.6,,,percent of total billed charges,88.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,31.04,32,,,percent of total billed charges,32% of total billed charges,77.6,80,,,percent of total billed charges,80% of total billed charges,77.6,80,,,percent of total billed charges,80% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,88.27,91,,,percent of total billed charges,91% of total billed charges,31.66,32.64,,,percent of total billed charges,32.64% of total billed charges,31.04,32,,,percent of total billed charges,32% of total billed charges,32.59,33.6,,,percent of total billed charges,33.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,31.04,32,,,percent of total billed charges,32% of total billed charges,31.04,32,,,percent of total billed charges,32% of total billed charges,89.24,92,,,percent of total billed charges,92% of total billed charges,29.37,89.24,
EVACUATION SUBUNGAL HEMATOMA,1000227,CDM,450,RC,11740,HCPCS,Outpatient,,,59,50.15,,47.91,81.2,,,percent of total billed charges,81.2% of total billed charges,19.26,32.64,,,percent of total billed charges,32.64% of total billed charges,43.66,74,,,percent of total billed charges,74% of total billed charges,43.66,74,,,percent of total billed charges,74% of total billed charges,18.88,32,,,percent of total billed charges,32% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,18.88,32,,,percent of total billed charges,32% of total billed charges,41.89,71,,,percent of total billed charges,71% of total billed charges,41.89,71,,,percent of total billed charges,71% of total billed charges,39.53,67,,,percent of total billed charges,67% of total billed charges,39.53,67,,,percent of total billed charges,67% of total billed charges,41.89,71,,,percent of total billed charges,71% of total billed charges,44.84,76,,,percent of total billed charges,76% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,19.45,32.96,,,percent of total billed charges,32.96% of total billed charges,30.84,105,,,Fee Schedule,pays based on EAPG rates,53.1,90,,,percent of total billed charges,90% of total billed charges,53.1,90,,,percent of total billed charges,90% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,52.27,88.6,,,percent of total billed charges,88.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,18.88,32,,,percent of total billed charges,32% of total billed charges,47.2,80,,,percent of total billed charges,80% of total billed charges,47.2,80,,,percent of total billed charges,80% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,53.69,91,,,percent of total billed charges,91% of total billed charges,19.26,32.64,,,percent of total billed charges,32.64% of total billed charges,18.88,32,,,percent of total billed charges,32% of total billed charges,19.82,33.6,,,percent of total billed charges,33.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,18.88,32,,,percent of total billed charges,32% of total billed charges,18.88,32,,,percent of total billed charges,32% of total billed charges,54.28,92,,,percent of total billed charges,92% of total billed charges,18.88,54.28,
EXCISION NAIL MATNX PERMANENT REMOVAL,1000269,CDM,450,RC,11750,HCPCS,Outpatient,,,319,271.15,,259.03,81.2,,,percent of total billed charges,81.2% of total billed charges,104.12,32.64,,,percent of total billed charges,32.64% of total billed charges,236.06,74,,,percent of total billed charges,74% of total billed charges,236.06,74,,,percent of total billed charges,74% of total billed charges,102.08,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,102.08,32,,,percent of total billed charges,32% of total billed charges,226.49,71,,,percent of total billed charges,71% of total billed charges,226.49,71,,,percent of total billed charges,71% of total billed charges,213.73,67,,,percent of total billed charges,67% of total billed charges,213.73,67,,,percent of total billed charges,67% of total billed charges,226.49,71,,,percent of total billed charges,71% of total billed charges,242.44,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,105.14,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,287.1,90,,,percent of total billed charges,90% of total billed charges,287.1,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,282.63,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,102.08,32,,,percent of total billed charges,32% of total billed charges,255.2,80,,,percent of total billed charges,80% of total billed charges,255.2,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,290.29,91,,,percent of total billed charges,91% of total billed charges,104.12,32.64,,,percent of total billed charges,32.64% of total billed charges,102.08,32,,,percent of total billed charges,32% of total billed charges,107.18,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,102.08,32,,,percent of total billed charges,32% of total billed charges,102.08,32,,,percent of total billed charges,32% of total billed charges,293.48,92,,,percent of total billed charges,92% of total billed charges,102.08,293.48,
REPAIR NAIL BED,1000198,CDM,450,RC,11760,HCPCS,Outpatient,,,273,232.05,,221.68,81.2,,,percent of total billed charges,81.2% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,207.48,76,,,percent of total billed charges,76% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,89.98,32.96,,,percent of total billed charges,32.96% of total billed charges,30.84,105,,,Fee Schedule,pays based on EAPG rates,245.7,90,,,percent of total billed charges,90% of total billed charges,245.7,90,,,percent of total billed charges,90% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,241.88,88.6,,,percent of total billed charges,88.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,248.43,91,,,percent of total billed charges,91% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,91.73,33.6,,,percent of total billed charges,33.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,251.16,92,,,percent of total billed charges,92% of total billed charges,29.37,251.16,
WEDGE EXCISION OF SKIN OF NAIL FOLD,1000055,CDM,450,RC,11765,HCPCS,Outpatient,,,121,102.85,,98.25,81.2,,,percent of total billed charges,81.2% of total billed charges,39.49,32.64,,,percent of total billed charges,32.64% of total billed charges,89.54,74,,,percent of total billed charges,74% of total billed charges,89.54,74,,,percent of total billed charges,74% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,81.07,67,,,percent of total billed charges,67% of total billed charges,81.07,67,,,percent of total billed charges,67% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,91.96,76,,,percent of total billed charges,76% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,39.88,32.96,,,percent of total billed charges,32.96% of total billed charges,30.84,105,,,Fee Schedule,pays based on EAPG rates,108.9,90,,,percent of total billed charges,90% of total billed charges,108.9,90,,,percent of total billed charges,90% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,107.21,88.6,,,percent of total billed charges,88.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,96.8,80,,,percent of total billed charges,80% of total billed charges,96.8,80,,,percent of total billed charges,80% of total billed charges,29.37,100,,,Fee Schedule,pays based on EAPG rates,110.11,91,,,percent of total billed charges,91% of total billed charges,39.49,32.64,,,percent of total billed charges,32.64% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,40.66,33.6,,,percent of total billed charges,33.6% of total billed charges,30.25,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,111.32,92,,,percent of total billed charges,92% of total billed charges,29.37,111.32,
EXCISION OF PILONIDAL CYST/SINUS SIMPLE,1000056,CDM,450,RC,11770,HCPCS,Outpatient,,,443,376.55,,359.72,81.2,,,percent of total billed charges,81.2% of total billed charges,144.6,32.64,,,percent of total billed charges,32.64% of total billed charges,327.82,74,,,percent of total billed charges,74% of total billed charges,327.82,74,,,percent of total billed charges,74% of total billed charges,141.76,32,,,percent of total billed charges,32% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,141.76,32,,,percent of total billed charges,32% of total billed charges,314.53,71,,,percent of total billed charges,71% of total billed charges,314.53,71,,,percent of total billed charges,71% of total billed charges,296.81,67,,,percent of total billed charges,67% of total billed charges,296.81,67,,,percent of total billed charges,67% of total billed charges,314.53,71,,,percent of total billed charges,71% of total billed charges,336.68,76,,,percent of total billed charges,76% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,146.01,32.96,,,percent of total billed charges,32.96% of total billed charges,685.99,105,,,Fee Schedule,pays based on EAPG rates,398.7,90,,,percent of total billed charges,90% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,392.5,88.6,,,percent of total billed charges,88.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,141.76,32,,,percent of total billed charges,32% of total billed charges,354.4,80,,,percent of total billed charges,80% of total billed charges,354.4,80,,,percent of total billed charges,80% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,403.13,91,,,percent of total billed charges,91% of total billed charges,144.6,32.64,,,percent of total billed charges,32.64% of total billed charges,141.76,32,,,percent of total billed charges,32% of total billed charges,148.85,33.6,,,percent of total billed charges,33.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,141.76,32,,,percent of total billed charges,32% of total billed charges,141.76,32,,,percent of total billed charges,32% of total billed charges,407.56,92,,,percent of total billed charges,92% of total billed charges,141.76,685.99,
EXCISION PILONIDAL CYST/SINUS EXTENSIVE,1000057,CDM,450,RC,11771,HCPCS,Outpatient,,,1007,855.95,,817.68,81.2,,,percent of total billed charges,81.2% of total billed charges,328.68,32.64,,,percent of total billed charges,32.64% of total billed charges,745.18,74,,,percent of total billed charges,74% of total billed charges,745.18,74,,,percent of total billed charges,74% of total billed charges,322.24,32,,,percent of total billed charges,32% of total billed charges,1087.45,103,,,Fee Schedule,pays based on EAPG rates,322.24,32,,,percent of total billed charges,32% of total billed charges,714.97,71,,,percent of total billed charges,71% of total billed charges,714.97,71,,,percent of total billed charges,71% of total billed charges,674.69,67,,,percent of total billed charges,67% of total billed charges,674.69,67,,,percent of total billed charges,67% of total billed charges,714.97,71,,,percent of total billed charges,71% of total billed charges,765.32,76,,,percent of total billed charges,76% of total billed charges,1087.45,103,,,Fee Schedule,pays based on EAPG rates,331.91,32.96,,,percent of total billed charges,32.96% of total billed charges,1108.56,105,,,Fee Schedule,pays based on EAPG rates,906.3,90,,,percent of total billed charges,90% of total billed charges,906.3,90,,,percent of total billed charges,90% of total billed charges,1055.77,100,,,Fee Schedule,pays based on EAPG rates,892.2,88.6,,,percent of total billed charges,88.6% of total billed charges,1087.45,103,,,Fee Schedule,pays based on EAPG rates,322.24,32,,,percent of total billed charges,32% of total billed charges,805.6,80,,,percent of total billed charges,80% of total billed charges,805.6,80,,,percent of total billed charges,80% of total billed charges,1055.77,100,,,Fee Schedule,pays based on EAPG rates,916.37,91,,,percent of total billed charges,91% of total billed charges,328.68,32.64,,,percent of total billed charges,32.64% of total billed charges,322.24,32,,,percent of total billed charges,32% of total billed charges,338.35,33.6,,,percent of total billed charges,33.6% of total billed charges,1087.45,103,,,Fee Schedule,pays based on EAPG rates,322.24,32,,,percent of total billed charges,32% of total billed charges,322.24,32,,,percent of total billed charges,32% of total billed charges,926.44,92,,,percent of total billed charges,92% of total billed charges,322.24,1108.56,
EXCISION PILONIDAL CYST/SINUS COMPLICATE,1000058,CDM,450,RC,11772,HCPCS,Outpatient,,,1215,1032.75,,986.58,81.2,,,percent of total billed charges,81.2% of total billed charges,396.58,32.64,,,percent of total billed charges,32.64% of total billed charges,899.1,74,,,percent of total billed charges,74% of total billed charges,899.1,74,,,percent of total billed charges,74% of total billed charges,388.8,32,,,percent of total billed charges,32% of total billed charges,1087.45,103,,,Fee Schedule,pays based on EAPG rates,388.8,32,,,percent of total billed charges,32% of total billed charges,862.65,71,,,percent of total billed charges,71% of total billed charges,862.65,71,,,percent of total billed charges,71% of total billed charges,814.05,67,,,percent of total billed charges,67% of total billed charges,814.05,67,,,percent of total billed charges,67% of total billed charges,862.65,71,,,percent of total billed charges,71% of total billed charges,923.4,76,,,percent of total billed charges,76% of total billed charges,1087.45,103,,,Fee Schedule,pays based on EAPG rates,400.46,32.96,,,percent of total billed charges,32.96% of total billed charges,1108.56,105,,,Fee Schedule,pays based on EAPG rates,1093.5,90,,,percent of total billed charges,90% of total billed charges,1093.5,90,,,percent of total billed charges,90% of total billed charges,1055.77,100,,,Fee Schedule,pays based on EAPG rates,1076.49,88.6,,,percent of total billed charges,88.6% of total billed charges,1087.45,103,,,Fee Schedule,pays based on EAPG rates,388.8,32,,,percent of total billed charges,32% of total billed charges,972,80,,,percent of total billed charges,80% of total billed charges,972,80,,,percent of total billed charges,80% of total billed charges,1055.77,100,,,Fee Schedule,pays based on EAPG rates,1105.65,91,,,percent of total billed charges,91% of total billed charges,396.58,32.64,,,percent of total billed charges,32.64% of total billed charges,388.8,32,,,percent of total billed charges,32% of total billed charges,408.24,33.6,,,percent of total billed charges,33.6% of total billed charges,1087.45,103,,,Fee Schedule,pays based on EAPG rates,388.8,32,,,percent of total billed charges,32% of total billed charges,388.8,32,,,percent of total billed charges,32% of total billed charges,1117.8,92,,,percent of total billed charges,92% of total billed charges,388.8,1117.8,
SIMPLE REPAIR SUPER WOUND/SNGTHF<2.5CM,1000059,CDM,450,RC,12001,HCPCS,Outpatient,,,290,246.5,,235.48,81.2,,,percent of total billed charges,81.2% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,220.4,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,95.58,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,261,90,,,percent of total billed charges,90% of total billed charges,261,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,256.94,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,263.9,91,,,percent of total billed charges,91% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,97.44,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,266.8,92,,,percent of total billed charges,92% of total billed charges,92.8,266.8,
SIMPLE REPAIR SUPER WOUNDS SNGTE 2.6-7.5,1000060,CDM,450,RC,12002,HCPCS,Outpatient,,,318,270.3,,258.22,81.2,,,percent of total billed charges,81.2% of total billed charges,103.8,32.64,,,percent of total billed charges,32.64% of total billed charges,235.32,74,,,percent of total billed charges,74% of total billed charges,235.32,74,,,percent of total billed charges,74% of total billed charges,101.76,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,101.76,32,,,percent of total billed charges,32% of total billed charges,225.78,71,,,percent of total billed charges,71% of total billed charges,225.78,71,,,percent of total billed charges,71% of total billed charges,213.06,67,,,percent of total billed charges,67% of total billed charges,213.06,67,,,percent of total billed charges,67% of total billed charges,225.78,71,,,percent of total billed charges,71% of total billed charges,241.68,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,104.81,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,286.2,90,,,percent of total billed charges,90% of total billed charges,286.2,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,281.75,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,101.76,32,,,percent of total billed charges,32% of total billed charges,254.4,80,,,percent of total billed charges,80% of total billed charges,254.4,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,289.38,91,,,percent of total billed charges,91% of total billed charges,103.8,32.64,,,percent of total billed charges,32.64% of total billed charges,101.76,32,,,percent of total billed charges,32% of total billed charges,106.85,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,101.76,32,,,percent of total billed charges,32% of total billed charges,101.76,32,,,percent of total billed charges,32% of total billed charges,292.56,92,,,percent of total billed charges,92% of total billed charges,101.76,292.56,
SIMP REPAIR SUPER WOUND SNGTE 7.6-12.5CM,1000061,CDM,450,RC,12004,HCPCS,Outpatient,,,382,324.7,,310.18,81.2,,,percent of total billed charges,81.2% of total billed charges,124.68,32.64,,,percent of total billed charges,32.64% of total billed charges,282.68,74,,,percent of total billed charges,74% of total billed charges,282.68,74,,,percent of total billed charges,74% of total billed charges,122.24,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,122.24,32,,,percent of total billed charges,32% of total billed charges,271.22,71,,,percent of total billed charges,71% of total billed charges,271.22,71,,,percent of total billed charges,71% of total billed charges,255.94,67,,,percent of total billed charges,67% of total billed charges,255.94,67,,,percent of total billed charges,67% of total billed charges,271.22,71,,,percent of total billed charges,71% of total billed charges,290.32,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,125.91,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,343.8,90,,,percent of total billed charges,90% of total billed charges,343.8,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,338.45,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,122.24,32,,,percent of total billed charges,32% of total billed charges,305.6,80,,,percent of total billed charges,80% of total billed charges,305.6,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,347.62,91,,,percent of total billed charges,91% of total billed charges,124.68,32.64,,,percent of total billed charges,32.64% of total billed charges,122.24,32,,,percent of total billed charges,32% of total billed charges,128.35,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,122.24,32,,,percent of total billed charges,32% of total billed charges,122.24,32,,,percent of total billed charges,32% of total billed charges,351.44,92,,,percent of total billed charges,92% of total billed charges,114.73,351.44,
SIMP RPR SUPER WOUND SNGTE 12.6 - 20CM,1000062,CDM,450,RC,12005,HCPCS,Outpatient,,,485,412.25,,393.82,81.2,,,percent of total billed charges,81.2% of total billed charges,158.3,32.64,,,percent of total billed charges,32.64% of total billed charges,358.9,74,,,percent of total billed charges,74% of total billed charges,358.9,74,,,percent of total billed charges,74% of total billed charges,155.2,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,155.2,32,,,percent of total billed charges,32% of total billed charges,344.35,71,,,percent of total billed charges,71% of total billed charges,344.35,71,,,percent of total billed charges,71% of total billed charges,324.95,67,,,percent of total billed charges,67% of total billed charges,324.95,67,,,percent of total billed charges,67% of total billed charges,344.35,71,,,percent of total billed charges,71% of total billed charges,368.6,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,159.86,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,436.5,90,,,percent of total billed charges,90% of total billed charges,436.5,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,429.71,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,155.2,32,,,percent of total billed charges,32% of total billed charges,388,80,,,percent of total billed charges,80% of total billed charges,388,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,441.35,91,,,percent of total billed charges,91% of total billed charges,158.3,32.64,,,percent of total billed charges,32.64% of total billed charges,155.2,32,,,percent of total billed charges,32% of total billed charges,162.96,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,155.2,32,,,percent of total billed charges,32% of total billed charges,155.2,32,,,percent of total billed charges,32% of total billed charges,446.2,92,,,percent of total billed charges,92% of total billed charges,114.73,446.2,
SIMP REPAIR SUPER WOUND SNGTE 20.1-30.CM,1000063,CDM,450,RC,12006,HCPCS,Outpatient,,,619,526.15,,502.63,81.2,,,percent of total billed charges,81.2% of total billed charges,202.04,32.64,,,percent of total billed charges,32.64% of total billed charges,458.06,74,,,percent of total billed charges,74% of total billed charges,458.06,74,,,percent of total billed charges,74% of total billed charges,198.08,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,198.08,32,,,percent of total billed charges,32% of total billed charges,439.49,71,,,percent of total billed charges,71% of total billed charges,439.49,71,,,percent of total billed charges,71% of total billed charges,414.73,67,,,percent of total billed charges,67% of total billed charges,414.73,67,,,percent of total billed charges,67% of total billed charges,439.49,71,,,percent of total billed charges,71% of total billed charges,470.44,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,204.02,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,557.1,90,,,percent of total billed charges,90% of total billed charges,557.1,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,548.43,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,198.08,32,,,percent of total billed charges,32% of total billed charges,495.2,80,,,percent of total billed charges,80% of total billed charges,495.2,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,563.29,91,,,percent of total billed charges,91% of total billed charges,202.04,32.64,,,percent of total billed charges,32.64% of total billed charges,198.08,32,,,percent of total billed charges,32% of total billed charges,207.98,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,198.08,32,,,percent of total billed charges,32% of total billed charges,198.08,32,,,percent of total billed charges,32% of total billed charges,569.48,92,,,percent of total billed charges,92% of total billed charges,114.73,569.48,
SIMP REPAIR SUPER WOUND SNGTE >30.0CM,1000064,CDM,450,RC,12007,HCPCS,Outpatient,,,695,590.75,,564.34,81.2,,,percent of total billed charges,81.2% of total billed charges,226.85,32.64,,,percent of total billed charges,32.64% of total billed charges,514.3,74,,,percent of total billed charges,74% of total billed charges,514.3,74,,,percent of total billed charges,74% of total billed charges,222.4,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,222.4,32,,,percent of total billed charges,32% of total billed charges,493.45,71,,,percent of total billed charges,71% of total billed charges,493.45,71,,,percent of total billed charges,71% of total billed charges,465.65,67,,,percent of total billed charges,67% of total billed charges,465.65,67,,,percent of total billed charges,67% of total billed charges,493.45,71,,,percent of total billed charges,71% of total billed charges,528.2,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,229.07,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,625.5,90,,,percent of total billed charges,90% of total billed charges,625.5,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,615.77,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,222.4,32,,,percent of total billed charges,32% of total billed charges,556,80,,,percent of total billed charges,80% of total billed charges,556,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,632.45,91,,,percent of total billed charges,91% of total billed charges,226.85,32.64,,,percent of total billed charges,32.64% of total billed charges,222.4,32,,,percent of total billed charges,32% of total billed charges,233.52,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,222.4,32,,,percent of total billed charges,32% of total billed charges,222.4,32,,,percent of total billed charges,32% of total billed charges,639.4,92,,,percent of total billed charges,92% of total billed charges,114.73,639.4,
SIMP REPAIR SUPER WOUND FEENLM <2.5CM,1000065,CDM,450,RC,12011,HCPCS,Outpatient,,,300,255,,243.6,81.2,,,percent of total billed charges,81.2% of total billed charges,97.92,32.64,,,percent of total billed charges,32.64% of total billed charges,222,74,,,percent of total billed charges,74% of total billed charges,222,74,,,percent of total billed charges,74% of total billed charges,96,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,96,32,,,percent of total billed charges,32% of total billed charges,213,71,,,percent of total billed charges,71% of total billed charges,213,71,,,percent of total billed charges,71% of total billed charges,201,67,,,percent of total billed charges,67% of total billed charges,201,67,,,percent of total billed charges,67% of total billed charges,213,71,,,percent of total billed charges,71% of total billed charges,228,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,98.88,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,270,90,,,percent of total billed charges,90% of total billed charges,270,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,265.8,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,96,32,,,percent of total billed charges,32% of total billed charges,240,80,,,percent of total billed charges,80% of total billed charges,240,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,273,91,,,percent of total billed charges,91% of total billed charges,97.92,32.64,,,percent of total billed charges,32.64% of total billed charges,96,32,,,percent of total billed charges,32% of total billed charges,100.8,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,96,32,,,percent of total billed charges,32% of total billed charges,96,32,,,percent of total billed charges,32% of total billed charges,276,92,,,percent of total billed charges,92% of total billed charges,96,276,
SIMP REPAIR SUPER WOUND FEENLM 2.6-5CM,1000066,CDM,450,RC,12013,HCPCS,Outpatient,,,337,286.45,,273.64,81.2,,,percent of total billed charges,81.2% of total billed charges,110,32.64,,,percent of total billed charges,32.64% of total billed charges,249.38,74,,,percent of total billed charges,74% of total billed charges,249.38,74,,,percent of total billed charges,74% of total billed charges,107.84,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,107.84,32,,,percent of total billed charges,32% of total billed charges,239.27,71,,,percent of total billed charges,71% of total billed charges,239.27,71,,,percent of total billed charges,71% of total billed charges,225.79,67,,,percent of total billed charges,67% of total billed charges,225.79,67,,,percent of total billed charges,67% of total billed charges,239.27,71,,,percent of total billed charges,71% of total billed charges,256.12,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,111.08,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,303.3,90,,,percent of total billed charges,90% of total billed charges,303.3,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,298.58,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,107.84,32,,,percent of total billed charges,32% of total billed charges,269.6,80,,,percent of total billed charges,80% of total billed charges,269.6,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,306.67,91,,,percent of total billed charges,91% of total billed charges,110,32.64,,,percent of total billed charges,32.64% of total billed charges,107.84,32,,,percent of total billed charges,32% of total billed charges,113.23,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,107.84,32,,,percent of total billed charges,32% of total billed charges,107.84,32,,,percent of total billed charges,32% of total billed charges,310.04,92,,,percent of total billed charges,92% of total billed charges,107.84,310.04,
SIMP REPAIR SUPER WOUND FEENLM 5.1-7.5CM,1000067,CDM,450,RC,12014,HCPCS,Outpatient,,,417,354.45,,338.6,81.2,,,percent of total billed charges,81.2% of total billed charges,136.11,32.64,,,percent of total billed charges,32.64% of total billed charges,308.58,74,,,percent of total billed charges,74% of total billed charges,308.58,74,,,percent of total billed charges,74% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,133.44,32,,,percent of total billed charges,32% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,279.39,67,,,percent of total billed charges,67% of total billed charges,279.39,67,,,percent of total billed charges,67% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,316.92,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,137.44,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,375.3,90,,,percent of total billed charges,90% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,369.46,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,133.44,32,,,percent of total billed charges,32% of total billed charges,333.6,80,,,percent of total billed charges,80% of total billed charges,333.6,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,379.47,91,,,percent of total billed charges,91% of total billed charges,136.11,32.64,,,percent of total billed charges,32.64% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,140.11,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,133.44,32,,,percent of total billed charges,32% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,383.64,92,,,percent of total billed charges,92% of total billed charges,114.73,383.64,
SIMP RPR SPRFCL WND FEENLM 7.6-12.5CM,1000068,CDM,450,RC,12015,HCPCS,Outpatient,,,542,460.7,,440.1,81.2,,,percent of total billed charges,81.2% of total billed charges,176.91,32.64,,,percent of total billed charges,32.64% of total billed charges,401.08,74,,,percent of total billed charges,74% of total billed charges,401.08,74,,,percent of total billed charges,74% of total billed charges,173.44,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,173.44,32,,,percent of total billed charges,32% of total billed charges,384.82,71,,,percent of total billed charges,71% of total billed charges,384.82,71,,,percent of total billed charges,71% of total billed charges,363.14,67,,,percent of total billed charges,67% of total billed charges,363.14,67,,,percent of total billed charges,67% of total billed charges,384.82,71,,,percent of total billed charges,71% of total billed charges,411.92,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,178.64,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,487.8,90,,,percent of total billed charges,90% of total billed charges,487.8,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,480.21,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,173.44,32,,,percent of total billed charges,32% of total billed charges,433.6,80,,,percent of total billed charges,80% of total billed charges,433.6,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,493.22,91,,,percent of total billed charges,91% of total billed charges,176.91,32.64,,,percent of total billed charges,32.64% of total billed charges,173.44,32,,,percent of total billed charges,32% of total billed charges,182.11,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,173.44,32,,,percent of total billed charges,32% of total billed charges,173.44,32,,,percent of total billed charges,32% of total billed charges,498.64,92,,,percent of total billed charges,92% of total billed charges,114.73,498.64,
SIMP RPR SPRFCL WND FEENLM 12.6-20CM,1000069,CDM,450,RC,12016,HCPCS,Outpatient,,,664,564.4,,539.17,81.2,,,percent of total billed charges,81.2% of total billed charges,216.73,32.64,,,percent of total billed charges,32.64% of total billed charges,491.36,74,,,percent of total billed charges,74% of total billed charges,491.36,74,,,percent of total billed charges,74% of total billed charges,212.48,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,212.48,32,,,percent of total billed charges,32% of total billed charges,471.44,71,,,percent of total billed charges,71% of total billed charges,471.44,71,,,percent of total billed charges,71% of total billed charges,444.88,67,,,percent of total billed charges,67% of total billed charges,444.88,67,,,percent of total billed charges,67% of total billed charges,471.44,71,,,percent of total billed charges,71% of total billed charges,504.64,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,218.85,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,597.6,90,,,percent of total billed charges,90% of total billed charges,597.6,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,588.3,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,212.48,32,,,percent of total billed charges,32% of total billed charges,531.2,80,,,percent of total billed charges,80% of total billed charges,531.2,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,604.24,91,,,percent of total billed charges,91% of total billed charges,216.73,32.64,,,percent of total billed charges,32.64% of total billed charges,212.48,32,,,percent of total billed charges,32% of total billed charges,223.1,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,212.48,32,,,percent of total billed charges,32% of total billed charges,212.48,32,,,percent of total billed charges,32% of total billed charges,610.88,92,,,percent of total billed charges,92% of total billed charges,114.73,610.88,
SIMP RPR SPRFCL WND FEENLM 20.1-30CM,1000070,CDM,450,RC,12017,HCPCS,Outpatient,,,793,674.05,,643.92,81.2,,,percent of total billed charges,81.2% of total billed charges,258.84,32.64,,,percent of total billed charges,32.64% of total billed charges,586.82,74,,,percent of total billed charges,74% of total billed charges,586.82,74,,,percent of total billed charges,74% of total billed charges,253.76,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,253.76,32,,,percent of total billed charges,32% of total billed charges,563.03,71,,,percent of total billed charges,71% of total billed charges,563.03,71,,,percent of total billed charges,71% of total billed charges,531.31,67,,,percent of total billed charges,67% of total billed charges,531.31,67,,,percent of total billed charges,67% of total billed charges,563.03,71,,,percent of total billed charges,71% of total billed charges,602.68,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,261.37,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,713.7,90,,,percent of total billed charges,90% of total billed charges,713.7,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,702.6,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,253.76,32,,,percent of total billed charges,32% of total billed charges,634.4,80,,,percent of total billed charges,80% of total billed charges,634.4,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,721.63,91,,,percent of total billed charges,91% of total billed charges,258.84,32.64,,,percent of total billed charges,32.64% of total billed charges,253.76,32,,,percent of total billed charges,32% of total billed charges,266.45,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,253.76,32,,,percent of total billed charges,32% of total billed charges,253.76,32,,,percent of total billed charges,32% of total billed charges,729.56,92,,,percent of total billed charges,92% of total billed charges,114.73,729.56,
SIMP RPR SPRFCL WND FEENLM >30.0CM,1000071,CDM,450,RC,12018,HCPCS,Outpatient,,,932,792.2,,756.78,81.2,,,percent of total billed charges,81.2% of total billed charges,304.2,32.64,,,percent of total billed charges,32.64% of total billed charges,689.68,74,,,percent of total billed charges,74% of total billed charges,689.68,74,,,percent of total billed charges,74% of total billed charges,298.24,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,298.24,32,,,percent of total billed charges,32% of total billed charges,661.72,71,,,percent of total billed charges,71% of total billed charges,661.72,71,,,percent of total billed charges,71% of total billed charges,624.44,67,,,percent of total billed charges,67% of total billed charges,624.44,67,,,percent of total billed charges,67% of total billed charges,661.72,71,,,percent of total billed charges,71% of total billed charges,708.32,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,307.19,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,838.8,90,,,percent of total billed charges,90% of total billed charges,838.8,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,825.75,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,298.24,32,,,percent of total billed charges,32% of total billed charges,745.6,80,,,percent of total billed charges,80% of total billed charges,745.6,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,848.12,91,,,percent of total billed charges,91% of total billed charges,304.2,32.64,,,percent of total billed charges,32.64% of total billed charges,298.24,32,,,percent of total billed charges,32% of total billed charges,313.15,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,298.24,32,,,percent of total billed charges,32% of total billed charges,298.24,32,,,percent of total billed charges,32% of total billed charges,857.44,92,,,percent of total billed charges,92% of total billed charges,114.73,857.44,
TX SPRFCL WND DEHISCENCE;SIMP CLOSURE,1000072,CDM,450,RC,12020,HCPCS,Outpatient,,,445,378.25,,361.34,81.2,,,percent of total billed charges,81.2% of total billed charges,145.25,32.64,,,percent of total billed charges,32.64% of total billed charges,329.3,74,,,percent of total billed charges,74% of total billed charges,329.3,74,,,percent of total billed charges,74% of total billed charges,142.4,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,142.4,32,,,percent of total billed charges,32% of total billed charges,315.95,71,,,percent of total billed charges,71% of total billed charges,315.95,71,,,percent of total billed charges,71% of total billed charges,298.15,67,,,percent of total billed charges,67% of total billed charges,298.15,67,,,percent of total billed charges,67% of total billed charges,315.95,71,,,percent of total billed charges,71% of total billed charges,338.2,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,146.67,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,400.5,90,,,percent of total billed charges,90% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,394.27,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,142.4,32,,,percent of total billed charges,32% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,404.95,91,,,percent of total billed charges,91% of total billed charges,145.25,32.64,,,percent of total billed charges,32.64% of total billed charges,142.4,32,,,percent of total billed charges,32% of total billed charges,149.52,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,142.4,32,,,percent of total billed charges,32% of total billed charges,142.4,32,,,percent of total billed charges,32% of total billed charges,409.4,92,,,percent of total billed charges,92% of total billed charges,142.4,409.4,
TX SPRFCL WND DEHISCENCES; W/ PACKING,1000073,CDM,450,RC,12021,HCPCS,Outpatient,,,316,268.6,,256.59,81.2,,,percent of total billed charges,81.2% of total billed charges,103.14,32.64,,,percent of total billed charges,32.64% of total billed charges,233.84,74,,,percent of total billed charges,74% of total billed charges,233.84,74,,,percent of total billed charges,74% of total billed charges,101.12,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,101.12,32,,,percent of total billed charges,32% of total billed charges,224.36,71,,,percent of total billed charges,71% of total billed charges,224.36,71,,,percent of total billed charges,71% of total billed charges,211.72,67,,,percent of total billed charges,67% of total billed charges,211.72,67,,,percent of total billed charges,67% of total billed charges,224.36,71,,,percent of total billed charges,71% of total billed charges,240.16,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,104.15,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,279.98,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,101.12,32,,,percent of total billed charges,32% of total billed charges,252.8,80,,,percent of total billed charges,80% of total billed charges,252.8,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,287.56,91,,,percent of total billed charges,91% of total billed charges,103.14,32.64,,,percent of total billed charges,32.64% of total billed charges,101.12,32,,,percent of total billed charges,32% of total billed charges,106.18,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,101.12,32,,,percent of total billed charges,32% of total billed charges,101.12,32,,,percent of total billed charges,32% of total billed charges,290.72,92,,,percent of total billed charges,92% of total billed charges,101.12,290.72,
RPR INTER WND SATE <2.5CM,1000074,CDM,450,RC,12031,HCPCS,Outpatient,,,364,309.4,,295.57,81.2,,,percent of total billed charges,81.2% of total billed charges,118.81,32.64,,,percent of total billed charges,32.64% of total billed charges,269.36,74,,,percent of total billed charges,74% of total billed charges,269.36,74,,,percent of total billed charges,74% of total billed charges,116.48,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,116.48,32,,,percent of total billed charges,32% of total billed charges,258.44,71,,,percent of total billed charges,71% of total billed charges,258.44,71,,,percent of total billed charges,71% of total billed charges,243.88,67,,,percent of total billed charges,67% of total billed charges,243.88,67,,,percent of total billed charges,67% of total billed charges,258.44,71,,,percent of total billed charges,71% of total billed charges,276.64,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,119.97,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,327.6,90,,,percent of total billed charges,90% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,322.5,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,116.48,32,,,percent of total billed charges,32% of total billed charges,291.2,80,,,percent of total billed charges,80% of total billed charges,291.2,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,331.24,91,,,percent of total billed charges,91% of total billed charges,118.81,32.64,,,percent of total billed charges,32.64% of total billed charges,116.48,32,,,percent of total billed charges,32% of total billed charges,122.3,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,116.48,32,,,percent of total billed charges,32% of total billed charges,116.48,32,,,percent of total billed charges,32% of total billed charges,334.88,92,,,percent of total billed charges,92% of total billed charges,116.48,334.88,
RPR INTER WND SATE 2.6 - 7.5CM,1000075,CDM,450,RC,12032,HCPCS,Outpatient,,,417,354.45,,338.6,81.2,,,percent of total billed charges,81.2% of total billed charges,136.11,32.64,,,percent of total billed charges,32.64% of total billed charges,308.58,74,,,percent of total billed charges,74% of total billed charges,308.58,74,,,percent of total billed charges,74% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,133.44,32,,,percent of total billed charges,32% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,279.39,67,,,percent of total billed charges,67% of total billed charges,279.39,67,,,percent of total billed charges,67% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,316.92,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,137.44,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,375.3,90,,,percent of total billed charges,90% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,369.46,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,133.44,32,,,percent of total billed charges,32% of total billed charges,333.6,80,,,percent of total billed charges,80% of total billed charges,333.6,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,379.47,91,,,percent of total billed charges,91% of total billed charges,136.11,32.64,,,percent of total billed charges,32.64% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,140.11,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,133.44,32,,,percent of total billed charges,32% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,383.64,92,,,percent of total billed charges,92% of total billed charges,133.44,383.64,
RPR INTER WND SATE 7.6 - 12.5CM,1000076,CDM,450,RC,12034,HCPCS,Outpatient,,,494,419.9,,401.13,81.2,,,percent of total billed charges,81.2% of total billed charges,161.24,32.64,,,percent of total billed charges,32.64% of total billed charges,365.56,74,,,percent of total billed charges,74% of total billed charges,365.56,74,,,percent of total billed charges,74% of total billed charges,158.08,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,158.08,32,,,percent of total billed charges,32% of total billed charges,350.74,71,,,percent of total billed charges,71% of total billed charges,350.74,71,,,percent of total billed charges,71% of total billed charges,330.98,67,,,percent of total billed charges,67% of total billed charges,330.98,67,,,percent of total billed charges,67% of total billed charges,350.74,71,,,percent of total billed charges,71% of total billed charges,375.44,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,162.82,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,444.6,90,,,percent of total billed charges,90% of total billed charges,444.6,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,437.68,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,158.08,32,,,percent of total billed charges,32% of total billed charges,395.2,80,,,percent of total billed charges,80% of total billed charges,395.2,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,449.54,91,,,percent of total billed charges,91% of total billed charges,161.24,32.64,,,percent of total billed charges,32.64% of total billed charges,158.08,32,,,percent of total billed charges,32% of total billed charges,165.98,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,158.08,32,,,percent of total billed charges,32% of total billed charges,158.08,32,,,percent of total billed charges,32% of total billed charges,454.48,92,,,percent of total billed charges,92% of total billed charges,147.31,454.48,
RPR INTER WND SATE 12.6 - 20.0CM,1000077,CDM,450,RC,12035,HCPCS,Outpatient,,,580,493,,470.96,81.2,,,percent of total billed charges,81.2% of total billed charges,189.31,32.64,,,percent of total billed charges,32.64% of total billed charges,429.2,74,,,percent of total billed charges,74% of total billed charges,429.2,74,,,percent of total billed charges,74% of total billed charges,185.6,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,185.6,32,,,percent of total billed charges,32% of total billed charges,411.8,71,,,percent of total billed charges,71% of total billed charges,411.8,71,,,percent of total billed charges,71% of total billed charges,388.6,67,,,percent of total billed charges,67% of total billed charges,388.6,67,,,percent of total billed charges,67% of total billed charges,411.8,71,,,percent of total billed charges,71% of total billed charges,440.8,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,191.17,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,522,90,,,percent of total billed charges,90% of total billed charges,522,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,513.88,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,185.6,32,,,percent of total billed charges,32% of total billed charges,464,80,,,percent of total billed charges,80% of total billed charges,464,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,527.8,91,,,percent of total billed charges,91% of total billed charges,189.31,32.64,,,percent of total billed charges,32.64% of total billed charges,185.6,32,,,percent of total billed charges,32% of total billed charges,194.88,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,185.6,32,,,percent of total billed charges,32% of total billed charges,185.6,32,,,percent of total billed charges,32% of total billed charges,533.6,92,,,percent of total billed charges,92% of total billed charges,147.31,533.6,
RPR INTER WND SATE 20.1 - 30.0CM,1000078,CDM,450,RC,12036,HCPCS,Outpatient,,,685,582.25,,556.22,81.2,,,percent of total billed charges,81.2% of total billed charges,223.58,32.64,,,percent of total billed charges,32.64% of total billed charges,506.9,74,,,percent of total billed charges,74% of total billed charges,506.9,74,,,percent of total billed charges,74% of total billed charges,219.2,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,219.2,32,,,percent of total billed charges,32% of total billed charges,486.35,71,,,percent of total billed charges,71% of total billed charges,486.35,71,,,percent of total billed charges,71% of total billed charges,458.95,67,,,percent of total billed charges,67% of total billed charges,458.95,67,,,percent of total billed charges,67% of total billed charges,486.35,71,,,percent of total billed charges,71% of total billed charges,520.6,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,225.78,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,616.5,90,,,percent of total billed charges,90% of total billed charges,616.5,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,606.91,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,219.2,32,,,percent of total billed charges,32% of total billed charges,548,80,,,percent of total billed charges,80% of total billed charges,548,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,623.35,91,,,percent of total billed charges,91% of total billed charges,223.58,32.64,,,percent of total billed charges,32.64% of total billed charges,219.2,32,,,percent of total billed charges,32% of total billed charges,230.16,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,219.2,32,,,percent of total billed charges,32% of total billed charges,219.2,32,,,percent of total billed charges,32% of total billed charges,630.2,92,,,percent of total billed charges,92% of total billed charges,147.31,630.2,
RPR INTER WND SATE >30.0CM,1000079,CDM,450,RC,12037,HCPCS,Outpatient,,,788,669.8,,639.86,81.2,,,percent of total billed charges,81.2% of total billed charges,257.2,32.64,,,percent of total billed charges,32.64% of total billed charges,583.12,74,,,percent of total billed charges,74% of total billed charges,583.12,74,,,percent of total billed charges,74% of total billed charges,252.16,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,252.16,32,,,percent of total billed charges,32% of total billed charges,559.48,71,,,percent of total billed charges,71% of total billed charges,559.48,71,,,percent of total billed charges,71% of total billed charges,527.96,67,,,percent of total billed charges,67% of total billed charges,527.96,67,,,percent of total billed charges,67% of total billed charges,559.48,71,,,percent of total billed charges,71% of total billed charges,598.88,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,259.72,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,709.2,90,,,percent of total billed charges,90% of total billed charges,709.2,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,698.17,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,252.16,32,,,percent of total billed charges,32% of total billed charges,630.4,80,,,percent of total billed charges,80% of total billed charges,630.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,717.08,91,,,percent of total billed charges,91% of total billed charges,257.2,32.64,,,percent of total billed charges,32.64% of total billed charges,252.16,32,,,percent of total billed charges,32% of total billed charges,264.77,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,252.16,32,,,percent of total billed charges,32% of total billed charges,252.16,32,,,percent of total billed charges,32% of total billed charges,724.96,92,,,percent of total billed charges,92% of total billed charges,147.31,724.96,
RPR INTER WND NHFG <2.5CM,1000080,CDM,450,RC,12041,HCPCS,Outpatient,,,402,341.7,,326.42,81.2,,,percent of total billed charges,81.2% of total billed charges,131.21,32.64,,,percent of total billed charges,32.64% of total billed charges,297.48,74,,,percent of total billed charges,74% of total billed charges,297.48,74,,,percent of total billed charges,74% of total billed charges,128.64,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,128.64,32,,,percent of total billed charges,32% of total billed charges,285.42,71,,,percent of total billed charges,71% of total billed charges,285.42,71,,,percent of total billed charges,71% of total billed charges,269.34,67,,,percent of total billed charges,67% of total billed charges,269.34,67,,,percent of total billed charges,67% of total billed charges,285.42,71,,,percent of total billed charges,71% of total billed charges,305.52,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,132.5,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,361.8,90,,,percent of total billed charges,90% of total billed charges,361.8,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,356.17,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,128.64,32,,,percent of total billed charges,32% of total billed charges,321.6,80,,,percent of total billed charges,80% of total billed charges,321.6,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,365.82,91,,,percent of total billed charges,91% of total billed charges,131.21,32.64,,,percent of total billed charges,32.64% of total billed charges,128.64,32,,,percent of total billed charges,32% of total billed charges,135.07,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,128.64,32,,,percent of total billed charges,32% of total billed charges,128.64,32,,,percent of total billed charges,32% of total billed charges,369.84,92,,,percent of total billed charges,92% of total billed charges,128.64,369.84,
RPR INTER WND NHFG 2.6-7.5CM,1000081,CDM,450,RC,12042,HCPCS,Outpatient,,,463,393.55,,375.96,81.2,,,percent of total billed charges,81.2% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,351.88,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,152.6,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,416.7,90,,,percent of total billed charges,90% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,410.22,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,421.33,91,,,percent of total billed charges,91% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,155.57,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,425.96,92,,,percent of total billed charges,92% of total billed charges,147.31,425.96,
RPR INTER WND NHFG 7.6-12.5CM,1000082,CDM,450,RC,12044,HCPCS,Outpatient,,,533,453.05,,432.8,81.2,,,percent of total billed charges,81.2% of total billed charges,173.97,32.64,,,percent of total billed charges,32.64% of total billed charges,394.42,74,,,percent of total billed charges,74% of total billed charges,394.42,74,,,percent of total billed charges,74% of total billed charges,170.56,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,170.56,32,,,percent of total billed charges,32% of total billed charges,378.43,71,,,percent of total billed charges,71% of total billed charges,378.43,71,,,percent of total billed charges,71% of total billed charges,357.11,67,,,percent of total billed charges,67% of total billed charges,357.11,67,,,percent of total billed charges,67% of total billed charges,378.43,71,,,percent of total billed charges,71% of total billed charges,405.08,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,175.68,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,479.7,90,,,percent of total billed charges,90% of total billed charges,479.7,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,472.24,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,170.56,32,,,percent of total billed charges,32% of total billed charges,426.4,80,,,percent of total billed charges,80% of total billed charges,426.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,485.03,91,,,percent of total billed charges,91% of total billed charges,173.97,32.64,,,percent of total billed charges,32.64% of total billed charges,170.56,32,,,percent of total billed charges,32% of total billed charges,179.09,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,170.56,32,,,percent of total billed charges,32% of total billed charges,170.56,32,,,percent of total billed charges,32% of total billed charges,490.36,92,,,percent of total billed charges,92% of total billed charges,147.31,490.36,
RPR INTER WND NHFG 12.6-20.0CM,1000083,CDM,450,RC,12045,HCPCS,Outpatient,,,615,522.75,,499.38,81.2,,,percent of total billed charges,81.2% of total billed charges,200.74,32.64,,,percent of total billed charges,32.64% of total billed charges,455.1,74,,,percent of total billed charges,74% of total billed charges,455.1,74,,,percent of total billed charges,74% of total billed charges,196.8,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,196.8,32,,,percent of total billed charges,32% of total billed charges,436.65,71,,,percent of total billed charges,71% of total billed charges,436.65,71,,,percent of total billed charges,71% of total billed charges,412.05,67,,,percent of total billed charges,67% of total billed charges,412.05,67,,,percent of total billed charges,67% of total billed charges,436.65,71,,,percent of total billed charges,71% of total billed charges,467.4,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,202.7,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,553.5,90,,,percent of total billed charges,90% of total billed charges,553.5,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,544.89,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,196.8,32,,,percent of total billed charges,32% of total billed charges,492,80,,,percent of total billed charges,80% of total billed charges,492,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,559.65,91,,,percent of total billed charges,91% of total billed charges,200.74,32.64,,,percent of total billed charges,32.64% of total billed charges,196.8,32,,,percent of total billed charges,32% of total billed charges,206.64,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,196.8,32,,,percent of total billed charges,32% of total billed charges,196.8,32,,,percent of total billed charges,32% of total billed charges,565.8,92,,,percent of total billed charges,92% of total billed charges,147.31,565.8,
RPR INTER WND NHFG 20.1 - 30.0CM,1000084,CDM,450,RC,12046,HCPCS,Outpatient,,,718,610.3,,583.02,81.2,,,percent of total billed charges,81.2% of total billed charges,234.36,32.64,,,percent of total billed charges,32.64% of total billed charges,531.32,74,,,percent of total billed charges,74% of total billed charges,531.32,74,,,percent of total billed charges,74% of total billed charges,229.76,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,229.76,32,,,percent of total billed charges,32% of total billed charges,509.78,71,,,percent of total billed charges,71% of total billed charges,509.78,71,,,percent of total billed charges,71% of total billed charges,481.06,67,,,percent of total billed charges,67% of total billed charges,481.06,67,,,percent of total billed charges,67% of total billed charges,509.78,71,,,percent of total billed charges,71% of total billed charges,545.68,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,236.65,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,646.2,90,,,percent of total billed charges,90% of total billed charges,646.2,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,636.15,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,229.76,32,,,percent of total billed charges,32% of total billed charges,574.4,80,,,percent of total billed charges,80% of total billed charges,574.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,653.38,91,,,percent of total billed charges,91% of total billed charges,234.36,32.64,,,percent of total billed charges,32.64% of total billed charges,229.76,32,,,percent of total billed charges,32% of total billed charges,241.25,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,229.76,32,,,percent of total billed charges,32% of total billed charges,229.76,32,,,percent of total billed charges,32% of total billed charges,660.56,92,,,percent of total billed charges,92% of total billed charges,147.31,660.56,
RPR INTER WND NHFG >30.00CM,1000085,CDM,450,RC,12047,HCPCS,Outpatient,,,785,667.25,,637.42,81.2,,,percent of total billed charges,81.2% of total billed charges,256.22,32.64,,,percent of total billed charges,32.64% of total billed charges,580.9,74,,,percent of total billed charges,74% of total billed charges,580.9,74,,,percent of total billed charges,74% of total billed charges,251.2,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,251.2,32,,,percent of total billed charges,32% of total billed charges,557.35,71,,,percent of total billed charges,71% of total billed charges,557.35,71,,,percent of total billed charges,71% of total billed charges,525.95,67,,,percent of total billed charges,67% of total billed charges,525.95,67,,,percent of total billed charges,67% of total billed charges,557.35,71,,,percent of total billed charges,71% of total billed charges,596.6,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,258.74,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,706.5,90,,,percent of total billed charges,90% of total billed charges,706.5,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,695.51,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,251.2,32,,,percent of total billed charges,32% of total billed charges,628,80,,,percent of total billed charges,80% of total billed charges,628,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,714.35,91,,,percent of total billed charges,91% of total billed charges,256.22,32.64,,,percent of total billed charges,32.64% of total billed charges,251.2,32,,,percent of total billed charges,32% of total billed charges,263.76,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,251.2,32,,,percent of total billed charges,32% of total billed charges,251.2,32,,,percent of total billed charges,32% of total billed charges,722.2,92,,,percent of total billed charges,92% of total billed charges,147.31,722.2,
RPR INTER WND FEENLM <2.5CM,1000086,CDM,450,RC,12051,HCPCS,Outpatient,,,418,355.3,,339.42,81.2,,,percent of total billed charges,81.2% of total billed charges,136.44,32.64,,,percent of total billed charges,32.64% of total billed charges,309.32,74,,,percent of total billed charges,74% of total billed charges,309.32,74,,,percent of total billed charges,74% of total billed charges,133.76,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,133.76,32,,,percent of total billed charges,32% of total billed charges,296.78,71,,,percent of total billed charges,71% of total billed charges,296.78,71,,,percent of total billed charges,71% of total billed charges,280.06,67,,,percent of total billed charges,67% of total billed charges,280.06,67,,,percent of total billed charges,67% of total billed charges,296.78,71,,,percent of total billed charges,71% of total billed charges,317.68,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,137.77,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,376.2,90,,,percent of total billed charges,90% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,370.35,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,133.76,32,,,percent of total billed charges,32% of total billed charges,334.4,80,,,percent of total billed charges,80% of total billed charges,334.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,380.38,91,,,percent of total billed charges,91% of total billed charges,136.44,32.64,,,percent of total billed charges,32.64% of total billed charges,133.76,32,,,percent of total billed charges,32% of total billed charges,140.45,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,133.76,32,,,percent of total billed charges,32% of total billed charges,133.76,32,,,percent of total billed charges,32% of total billed charges,384.56,92,,,percent of total billed charges,92% of total billed charges,133.76,384.56,
RPR INTER WND FEENLM 2.6-5.0CM,1000087,CDM,450,RC,12052,HCPCS,Outpatient,,,473,402.05,,384.08,81.2,,,percent of total billed charges,81.2% of total billed charges,154.39,32.64,,,percent of total billed charges,32.64% of total billed charges,350.02,74,,,percent of total billed charges,74% of total billed charges,350.02,74,,,percent of total billed charges,74% of total billed charges,151.36,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,151.36,32,,,percent of total billed charges,32% of total billed charges,335.83,71,,,percent of total billed charges,71% of total billed charges,335.83,71,,,percent of total billed charges,71% of total billed charges,316.91,67,,,percent of total billed charges,67% of total billed charges,316.91,67,,,percent of total billed charges,67% of total billed charges,335.83,71,,,percent of total billed charges,71% of total billed charges,359.48,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,155.9,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,425.7,90,,,percent of total billed charges,90% of total billed charges,425.7,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,419.08,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,151.36,32,,,percent of total billed charges,32% of total billed charges,378.4,80,,,percent of total billed charges,80% of total billed charges,378.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,430.43,91,,,percent of total billed charges,91% of total billed charges,154.39,32.64,,,percent of total billed charges,32.64% of total billed charges,151.36,32,,,percent of total billed charges,32% of total billed charges,158.93,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,151.36,32,,,percent of total billed charges,32% of total billed charges,151.36,32,,,percent of total billed charges,32% of total billed charges,435.16,92,,,percent of total billed charges,92% of total billed charges,147.31,435.16,
RPR INTER WND FEENLM 5.1-7.5CM,1000088,CDM,450,RC,12053,HCPCS,Outpatient,,,531,451.35,,431.17,81.2,,,percent of total billed charges,81.2% of total billed charges,173.32,32.64,,,percent of total billed charges,32.64% of total billed charges,392.94,74,,,percent of total billed charges,74% of total billed charges,392.94,74,,,percent of total billed charges,74% of total billed charges,169.92,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,169.92,32,,,percent of total billed charges,32% of total billed charges,377.01,71,,,percent of total billed charges,71% of total billed charges,377.01,71,,,percent of total billed charges,71% of total billed charges,355.77,67,,,percent of total billed charges,67% of total billed charges,355.77,67,,,percent of total billed charges,67% of total billed charges,377.01,71,,,percent of total billed charges,71% of total billed charges,403.56,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,175.02,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,477.9,90,,,percent of total billed charges,90% of total billed charges,477.9,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,470.47,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,169.92,32,,,percent of total billed charges,32% of total billed charges,424.8,80,,,percent of total billed charges,80% of total billed charges,424.8,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,483.21,91,,,percent of total billed charges,91% of total billed charges,173.32,32.64,,,percent of total billed charges,32.64% of total billed charges,169.92,32,,,percent of total billed charges,32% of total billed charges,178.42,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,169.92,32,,,percent of total billed charges,32% of total billed charges,169.92,32,,,percent of total billed charges,32% of total billed charges,488.52,92,,,percent of total billed charges,92% of total billed charges,147.31,488.52,
RPR INTER WND FEENLM 7.6 - 12.5CM,1000089,CDM,450,RC,12054,HCPCS,Outpatient,,,585,497.25,,475.02,81.2,,,percent of total billed charges,81.2% of total billed charges,190.94,32.64,,,percent of total billed charges,32.64% of total billed charges,432.9,74,,,percent of total billed charges,74% of total billed charges,432.9,74,,,percent of total billed charges,74% of total billed charges,187.2,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,187.2,32,,,percent of total billed charges,32% of total billed charges,415.35,71,,,percent of total billed charges,71% of total billed charges,415.35,71,,,percent of total billed charges,71% of total billed charges,391.95,67,,,percent of total billed charges,67% of total billed charges,391.95,67,,,percent of total billed charges,67% of total billed charges,415.35,71,,,percent of total billed charges,71% of total billed charges,444.6,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,192.82,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,526.5,90,,,percent of total billed charges,90% of total billed charges,526.5,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,518.31,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,187.2,32,,,percent of total billed charges,32% of total billed charges,468,80,,,percent of total billed charges,80% of total billed charges,468,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,532.35,91,,,percent of total billed charges,91% of total billed charges,190.94,32.64,,,percent of total billed charges,32.64% of total billed charges,187.2,32,,,percent of total billed charges,32% of total billed charges,196.56,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,187.2,32,,,percent of total billed charges,32% of total billed charges,187.2,32,,,percent of total billed charges,32% of total billed charges,538.2,92,,,percent of total billed charges,92% of total billed charges,147.31,538.2,
RPR INTER WND FEENLM 12.6-20.0CM,1000090,CDM,450,RC,12055,HCPCS,Outpatient,,,747,634.95,,606.56,81.2,,,percent of total billed charges,81.2% of total billed charges,243.82,32.64,,,percent of total billed charges,32.64% of total billed charges,552.78,74,,,percent of total billed charges,74% of total billed charges,552.78,74,,,percent of total billed charges,74% of total billed charges,239.04,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,239.04,32,,,percent of total billed charges,32% of total billed charges,530.37,71,,,percent of total billed charges,71% of total billed charges,530.37,71,,,percent of total billed charges,71% of total billed charges,500.49,67,,,percent of total billed charges,67% of total billed charges,500.49,67,,,percent of total billed charges,67% of total billed charges,530.37,71,,,percent of total billed charges,71% of total billed charges,567.72,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,246.21,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,672.3,90,,,percent of total billed charges,90% of total billed charges,672.3,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,661.84,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,239.04,32,,,percent of total billed charges,32% of total billed charges,597.6,80,,,percent of total billed charges,80% of total billed charges,597.6,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,679.77,91,,,percent of total billed charges,91% of total billed charges,243.82,32.64,,,percent of total billed charges,32.64% of total billed charges,239.04,32,,,percent of total billed charges,32% of total billed charges,250.99,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,239.04,32,,,percent of total billed charges,32% of total billed charges,239.04,32,,,percent of total billed charges,32% of total billed charges,687.24,92,,,percent of total billed charges,92% of total billed charges,147.31,687.24,
RPR INTER WND FEENLM 20.1 - 30.0CM,1000091,CDM,450,RC,12056,HCPCS,Outpatient,,,884,751.4,,717.81,81.2,,,percent of total billed charges,81.2% of total billed charges,288.54,32.64,,,percent of total billed charges,32.64% of total billed charges,654.16,74,,,percent of total billed charges,74% of total billed charges,654.16,74,,,percent of total billed charges,74% of total billed charges,282.88,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,282.88,32,,,percent of total billed charges,32% of total billed charges,627.64,71,,,percent of total billed charges,71% of total billed charges,627.64,71,,,percent of total billed charges,71% of total billed charges,592.28,67,,,percent of total billed charges,67% of total billed charges,592.28,67,,,percent of total billed charges,67% of total billed charges,627.64,71,,,percent of total billed charges,71% of total billed charges,671.84,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,291.37,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,795.6,90,,,percent of total billed charges,90% of total billed charges,795.6,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,783.22,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,282.88,32,,,percent of total billed charges,32% of total billed charges,707.2,80,,,percent of total billed charges,80% of total billed charges,707.2,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,804.44,91,,,percent of total billed charges,91% of total billed charges,288.54,32.64,,,percent of total billed charges,32.64% of total billed charges,282.88,32,,,percent of total billed charges,32% of total billed charges,297.02,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,282.88,32,,,percent of total billed charges,32% of total billed charges,282.88,32,,,percent of total billed charges,32% of total billed charges,813.28,92,,,percent of total billed charges,92% of total billed charges,147.31,813.28,
RPR INTER WND FEENLM >30.0CM,1000092,CDM,450,RC,12057,HCPCS,Outpatient,,,1006,855.1,,816.87,81.2,,,percent of total billed charges,81.2% of total billed charges,328.36,32.64,,,percent of total billed charges,32.64% of total billed charges,744.44,74,,,percent of total billed charges,74% of total billed charges,744.44,74,,,percent of total billed charges,74% of total billed charges,321.92,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,321.92,32,,,percent of total billed charges,32% of total billed charges,714.26,71,,,percent of total billed charges,71% of total billed charges,714.26,71,,,percent of total billed charges,71% of total billed charges,674.02,67,,,percent of total billed charges,67% of total billed charges,674.02,67,,,percent of total billed charges,67% of total billed charges,714.26,71,,,percent of total billed charges,71% of total billed charges,764.56,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,331.58,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,905.4,90,,,percent of total billed charges,90% of total billed charges,905.4,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,891.32,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,321.92,32,,,percent of total billed charges,32% of total billed charges,804.8,80,,,percent of total billed charges,80% of total billed charges,804.8,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,915.46,91,,,percent of total billed charges,91% of total billed charges,328.36,32.64,,,percent of total billed charges,32.64% of total billed charges,321.92,32,,,percent of total billed charges,32% of total billed charges,338.02,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,321.92,32,,,percent of total billed charges,32% of total billed charges,321.92,32,,,percent of total billed charges,32% of total billed charges,925.52,92,,,percent of total billed charges,92% of total billed charges,147.31,925.52,
"RPR COMPLEX SCALP, ARMS, LEGS 1.1-2.5CM",1000093,CDM,450,RC,13120,HCPCS,Outpatient,,,538,457.3,,436.86,81.2,,,percent of total billed charges,81.2% of total billed charges,175.6,32.64,,,percent of total billed charges,32.64% of total billed charges,398.12,74,,,percent of total billed charges,74% of total billed charges,398.12,74,,,percent of total billed charges,74% of total billed charges,172.16,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,172.16,32,,,percent of total billed charges,32% of total billed charges,381.98,71,,,percent of total billed charges,71% of total billed charges,381.98,71,,,percent of total billed charges,71% of total billed charges,360.46,67,,,percent of total billed charges,67% of total billed charges,360.46,67,,,percent of total billed charges,67% of total billed charges,381.98,71,,,percent of total billed charges,71% of total billed charges,408.88,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,177.32,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,484.2,90,,,percent of total billed charges,90% of total billed charges,484.2,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,476.67,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,172.16,32,,,percent of total billed charges,32% of total billed charges,430.4,80,,,percent of total billed charges,80% of total billed charges,430.4,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,489.58,91,,,percent of total billed charges,91% of total billed charges,175.6,32.64,,,percent of total billed charges,32.64% of total billed charges,172.16,32,,,percent of total billed charges,32% of total billed charges,180.77,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,172.16,32,,,percent of total billed charges,32% of total billed charges,172.16,32,,,percent of total billed charges,32% of total billed charges,494.96,92,,,percent of total billed charges,92% of total billed charges,172.16,494.96,
"REPAIR COMPLEX SCALP, ARMS, LEGS 2.6-7.5",1000094,CDM,450,RC,13121,HCPCS,Outpatient,,,770,654.5,,625.24,81.2,,,percent of total billed charges,81.2% of total billed charges,251.33,32.64,,,percent of total billed charges,32.64% of total billed charges,569.8,74,,,percent of total billed charges,74% of total billed charges,569.8,74,,,percent of total billed charges,74% of total billed charges,246.4,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,246.4,32,,,percent of total billed charges,32% of total billed charges,546.7,71,,,percent of total billed charges,71% of total billed charges,546.7,71,,,percent of total billed charges,71% of total billed charges,515.9,67,,,percent of total billed charges,67% of total billed charges,515.9,67,,,percent of total billed charges,67% of total billed charges,546.7,71,,,percent of total billed charges,71% of total billed charges,585.2,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,253.79,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,693,90,,,percent of total billed charges,90% of total billed charges,693,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,682.22,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,246.4,32,,,percent of total billed charges,32% of total billed charges,616,80,,,percent of total billed charges,80% of total billed charges,616,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,700.7,91,,,percent of total billed charges,91% of total billed charges,251.33,32.64,,,percent of total billed charges,32.64% of total billed charges,246.4,32,,,percent of total billed charges,32% of total billed charges,258.72,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,246.4,32,,,percent of total billed charges,32% of total billed charges,246.4,32,,,percent of total billed charges,32% of total billed charges,708.4,92,,,percent of total billed charges,92% of total billed charges,239.85,708.4,
RPR COMPLEX SAL EA ADD 5CM<,1000095,CDM,450,RC,13122,HCPCS,Outpatient,,,264,224.4,,214.37,81.2,,,percent of total billed charges,81.2% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,200.64,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,87.01,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,237.6,90,,,percent of total billed charges,90% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,233.9,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,240.24,91,,,percent of total billed charges,91% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,88.7,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,242.88,92,,,percent of total billed charges,92% of total billed charges,84.48,251.85,
RPR COMPLEX FCCMNAGHF 1.1-2.5CM,1000096,CDM,450,RC,13131,HCPCS,Outpatient,,,651,553.35,,528.61,81.2,,,percent of total billed charges,81.2% of total billed charges,212.49,32.64,,,percent of total billed charges,32.64% of total billed charges,481.74,74,,,percent of total billed charges,74% of total billed charges,481.74,74,,,percent of total billed charges,74% of total billed charges,208.32,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,208.32,32,,,percent of total billed charges,32% of total billed charges,462.21,71,,,percent of total billed charges,71% of total billed charges,462.21,71,,,percent of total billed charges,71% of total billed charges,436.17,67,,,percent of total billed charges,67% of total billed charges,436.17,67,,,percent of total billed charges,67% of total billed charges,462.21,71,,,percent of total billed charges,71% of total billed charges,494.76,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,214.57,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,585.9,90,,,percent of total billed charges,90% of total billed charges,585.9,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,576.79,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,208.32,32,,,percent of total billed charges,32% of total billed charges,520.8,80,,,percent of total billed charges,80% of total billed charges,520.8,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,592.41,91,,,percent of total billed charges,91% of total billed charges,212.49,32.64,,,percent of total billed charges,32.64% of total billed charges,208.32,32,,,percent of total billed charges,32% of total billed charges,218.74,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,208.32,32,,,percent of total billed charges,32% of total billed charges,208.32,32,,,percent of total billed charges,32% of total billed charges,598.92,92,,,percent of total billed charges,92% of total billed charges,208.32,598.92,
RPR CMPLX FCCMNAGHF 2.6-7.5,1000097,CDM,450,RC,13132,HCPCS,Outpatient,,,1082,919.7,,878.58,81.2,,,percent of total billed charges,81.2% of total billed charges,353.16,32.64,,,percent of total billed charges,32.64% of total billed charges,800.68,74,,,percent of total billed charges,74% of total billed charges,800.68,74,,,percent of total billed charges,74% of total billed charges,346.24,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,346.24,32,,,percent of total billed charges,32% of total billed charges,768.22,71,,,percent of total billed charges,71% of total billed charges,768.22,71,,,percent of total billed charges,71% of total billed charges,724.94,67,,,percent of total billed charges,67% of total billed charges,724.94,67,,,percent of total billed charges,67% of total billed charges,768.22,71,,,percent of total billed charges,71% of total billed charges,822.32,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,356.63,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,973.8,90,,,percent of total billed charges,90% of total billed charges,973.8,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,958.65,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,346.24,32,,,percent of total billed charges,32% of total billed charges,865.6,80,,,percent of total billed charges,80% of total billed charges,865.6,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,984.62,91,,,percent of total billed charges,91% of total billed charges,353.16,32.64,,,percent of total billed charges,32.64% of total billed charges,346.24,32,,,percent of total billed charges,32% of total billed charges,363.55,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,346.24,32,,,percent of total billed charges,32% of total billed charges,346.24,32,,,percent of total billed charges,32% of total billed charges,995.44,92,,,percent of total billed charges,92% of total billed charges,239.85,995.44,
RPR CMPLX FCCMNAGHF EA ADD 5CM<,1000098,CDM,450,RC,13133,HCPCS,Outpatient,,,385,327.25,,312.62,81.2,,,percent of total billed charges,81.2% of total billed charges,125.66,32.64,,,percent of total billed charges,32.64% of total billed charges,284.9,74,,,percent of total billed charges,74% of total billed charges,284.9,74,,,percent of total billed charges,74% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,257.95,67,,,percent of total billed charges,67% of total billed charges,257.95,67,,,percent of total billed charges,67% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,292.6,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,126.9,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,346.5,90,,,percent of total billed charges,90% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,341.11,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,308,80,,,percent of total billed charges,80% of total billed charges,308,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,350.35,91,,,percent of total billed charges,91% of total billed charges,125.66,32.64,,,percent of total billed charges,32.64% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,129.36,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,354.2,92,,,percent of total billed charges,92% of total billed charges,123.2,354.2,
RPR COMPLX EYELID/NOSE/EAR/LIP 1.1-2.5CM,1000241,CDM,450,RC,13151,HCPCS,Outpatient,,,730,620.5,,592.76,81.2,,,percent of total billed charges,81.2% of total billed charges,238.27,32.64,,,percent of total billed charges,32.64% of total billed charges,540.2,74,,,percent of total billed charges,74% of total billed charges,540.2,74,,,percent of total billed charges,74% of total billed charges,233.6,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,233.6,32,,,percent of total billed charges,32% of total billed charges,518.3,71,,,percent of total billed charges,71% of total billed charges,518.3,71,,,percent of total billed charges,71% of total billed charges,489.1,67,,,percent of total billed charges,67% of total billed charges,489.1,67,,,percent of total billed charges,67% of total billed charges,518.3,71,,,percent of total billed charges,71% of total billed charges,554.8,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,240.61,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,657,90,,,percent of total billed charges,90% of total billed charges,657,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,646.78,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,233.6,32,,,percent of total billed charges,32% of total billed charges,584,80,,,percent of total billed charges,80% of total billed charges,584,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,664.3,91,,,percent of total billed charges,91% of total billed charges,238.27,32.64,,,percent of total billed charges,32.64% of total billed charges,233.6,32,,,percent of total billed charges,32% of total billed charges,245.28,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,233.6,32,,,percent of total billed charges,32% of total billed charges,233.6,32,,,percent of total billed charges,32% of total billed charges,671.6,92,,,percent of total billed charges,92% of total billed charges,233.6,671.6,
RPR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5C,1000235,CDM,450,RC,13152,HCPCS,Outpatient,,,1037,881.45,,842.04,81.2,,,percent of total billed charges,81.2% of total billed charges,338.48,32.64,,,percent of total billed charges,32.64% of total billed charges,767.38,74,,,percent of total billed charges,74% of total billed charges,767.38,74,,,percent of total billed charges,74% of total billed charges,331.84,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,331.84,32,,,percent of total billed charges,32% of total billed charges,736.27,71,,,percent of total billed charges,71% of total billed charges,736.27,71,,,percent of total billed charges,71% of total billed charges,694.79,67,,,percent of total billed charges,67% of total billed charges,694.79,67,,,percent of total billed charges,67% of total billed charges,736.27,71,,,percent of total billed charges,71% of total billed charges,788.12,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,341.8,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,933.3,90,,,percent of total billed charges,90% of total billed charges,933.3,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,918.78,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,331.84,32,,,percent of total billed charges,32% of total billed charges,829.6,80,,,percent of total billed charges,80% of total billed charges,829.6,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,943.67,91,,,percent of total billed charges,91% of total billed charges,338.48,32.64,,,percent of total billed charges,32.64% of total billed charges,331.84,32,,,percent of total billed charges,32% of total billed charges,348.43,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,331.84,32,,,percent of total billed charges,32% of total billed charges,331.84,32,,,percent of total billed charges,32% of total billed charges,954.04,92,,,percent of total billed charges,92% of total billed charges,239.85,954.04,
"RPR COMPLEX E,N,E AND/OR L;EAC ADD 5CM<",1000243,CDM,450,RC,13153,HCPCS,Outpatient,,,387,328.95,,314.24,81.2,,,percent of total billed charges,81.2% of total billed charges,126.32,32.64,,,percent of total billed charges,32.64% of total billed charges,286.38,74,,,percent of total billed charges,74% of total billed charges,286.38,74,,,percent of total billed charges,74% of total billed charges,123.84,32,,,percent of total billed charges,32% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,123.84,32,,,percent of total billed charges,32% of total billed charges,274.77,71,,,percent of total billed charges,71% of total billed charges,274.77,71,,,percent of total billed charges,71% of total billed charges,259.29,67,,,percent of total billed charges,67% of total billed charges,259.29,67,,,percent of total billed charges,67% of total billed charges,274.77,71,,,percent of total billed charges,71% of total billed charges,294.12,76,,,percent of total billed charges,76% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,127.56,32.96,,,percent of total billed charges,32.96% of total billed charges,685.99,105,,,Fee Schedule,pays based on EAPG rates,348.3,90,,,percent of total billed charges,90% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,342.88,88.6,,,percent of total billed charges,88.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,123.84,32,,,percent of total billed charges,32% of total billed charges,309.6,80,,,percent of total billed charges,80% of total billed charges,309.6,80,,,percent of total billed charges,80% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,352.17,91,,,percent of total billed charges,91% of total billed charges,126.32,32.64,,,percent of total billed charges,32.64% of total billed charges,123.84,32,,,percent of total billed charges,32% of total billed charges,130.03,33.6,,,percent of total billed charges,33.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,123.84,32,,,percent of total billed charges,32% of total billed charges,123.84,32,,,percent of total billed charges,32% of total billed charges,356.04,92,,,percent of total billed charges,92% of total billed charges,123.84,685.99,
INITIAL TX FIRST DEGREE BURN,1000485,CDM,450,RC,16000,HCPCS,Outpatient,,,564,479.4,,457.97,81.2,,,percent of total billed charges,81.2% of total billed charges,184.09,32.64,,,percent of total billed charges,32.64% of total billed charges,417.36,74,,,percent of total billed charges,74% of total billed charges,417.36,74,,,percent of total billed charges,74% of total billed charges,180.48,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,180.48,32,,,percent of total billed charges,32% of total billed charges,400.44,71,,,percent of total billed charges,71% of total billed charges,400.44,71,,,percent of total billed charges,71% of total billed charges,377.88,67,,,percent of total billed charges,67% of total billed charges,377.88,67,,,percent of total billed charges,67% of total billed charges,400.44,71,,,percent of total billed charges,71% of total billed charges,428.64,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,185.89,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,507.6,90,,,percent of total billed charges,90% of total billed charges,507.6,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,499.7,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,180.48,32,,,percent of total billed charges,32% of total billed charges,451.2,80,,,percent of total billed charges,80% of total billed charges,451.2,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,513.24,91,,,percent of total billed charges,91% of total billed charges,184.09,32.64,,,percent of total billed charges,32.64% of total billed charges,180.48,32,,,percent of total billed charges,32% of total billed charges,189.5,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,180.48,32,,,percent of total billed charges,32% of total billed charges,180.48,32,,,percent of total billed charges,32% of total billed charges,518.88,92,,,percent of total billed charges,92% of total billed charges,114.73,518.88,
BURN CARE >5% BODY SURFACE,1000203,CDM,450,RC,16020,HCPCS,Outpatient,,,135,114.75,,109.62,81.2,,,percent of total billed charges,81.2% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,102.6,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,44.5,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,119.61,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,122.85,91,,,percent of total billed charges,91% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,45.36,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,124.2,92,,,percent of total billed charges,92% of total billed charges,43.2,124.2,
BURN CARE MED 5-10% BODY SURFACE,1000426,CDM,450,RC,16025,HCPCS,Outpatient,,,614,521.9,,498.57,81.2,,,percent of total billed charges,81.2% of total billed charges,200.41,32.64,,,percent of total billed charges,32.64% of total billed charges,454.36,74,,,percent of total billed charges,74% of total billed charges,454.36,74,,,percent of total billed charges,74% of total billed charges,196.48,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,196.48,32,,,percent of total billed charges,32% of total billed charges,435.94,71,,,percent of total billed charges,71% of total billed charges,435.94,71,,,percent of total billed charges,71% of total billed charges,411.38,67,,,percent of total billed charges,67% of total billed charges,411.38,67,,,percent of total billed charges,67% of total billed charges,435.94,71,,,percent of total billed charges,71% of total billed charges,466.64,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,202.37,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,552.6,90,,,percent of total billed charges,90% of total billed charges,552.6,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,544,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,196.48,32,,,percent of total billed charges,32% of total billed charges,491.2,80,,,percent of total billed charges,80% of total billed charges,491.2,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,558.74,91,,,percent of total billed charges,91% of total billed charges,200.41,32.64,,,percent of total billed charges,32.64% of total billed charges,196.48,32,,,percent of total billed charges,32% of total billed charges,206.3,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,196.48,32,,,percent of total billed charges,32% of total billed charges,196.48,32,,,percent of total billed charges,32% of total billed charges,564.88,92,,,percent of total billed charges,92% of total billed charges,114.73,564.88,
"EXPLORATION OF PENETRATING WND, NECK",1000099,CDM,450,RC,20100,HCPCS,Outpatient,,,1009,857.65,,819.31,81.2,,,percent of total billed charges,81.2% of total billed charges,329.34,32.64,,,percent of total billed charges,32.64% of total billed charges,746.66,74,,,percent of total billed charges,74% of total billed charges,746.66,74,,,percent of total billed charges,74% of total billed charges,322.88,32,,,percent of total billed charges,32% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,322.88,32,,,percent of total billed charges,32% of total billed charges,716.39,71,,,percent of total billed charges,71% of total billed charges,716.39,71,,,percent of total billed charges,71% of total billed charges,676.03,67,,,percent of total billed charges,67% of total billed charges,676.03,67,,,percent of total billed charges,67% of total billed charges,716.39,71,,,percent of total billed charges,71% of total billed charges,766.84,76,,,percent of total billed charges,76% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,332.57,32.96,,,percent of total billed charges,32.96% of total billed charges,361.98,105,,,Fee Schedule,pays based on EAPG rates,908.1,90,,,percent of total billed charges,90% of total billed charges,908.1,90,,,percent of total billed charges,90% of total billed charges,344.75,100,,,Fee Schedule,pays based on EAPG rates,893.97,88.6,,,percent of total billed charges,88.6% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,322.88,32,,,percent of total billed charges,32% of total billed charges,807.2,80,,,percent of total billed charges,80% of total billed charges,807.2,80,,,percent of total billed charges,80% of total billed charges,344.75,100,,,Fee Schedule,pays based on EAPG rates,918.19,91,,,percent of total billed charges,91% of total billed charges,329.34,32.64,,,percent of total billed charges,32.64% of total billed charges,322.88,32,,,percent of total billed charges,32% of total billed charges,339.02,33.6,,,percent of total billed charges,33.6% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,322.88,32,,,percent of total billed charges,32% of total billed charges,322.88,32,,,percent of total billed charges,32% of total billed charges,928.28,92,,,percent of total billed charges,92% of total billed charges,322.88,928.28,
"EXPLORATION OF PENETRATING WND, CHEST",1000100,CDM,450,RC,20101,HCPCS,Outpatient,,,543,461.55,,440.92,81.2,,,percent of total billed charges,81.2% of total billed charges,177.24,32.64,,,percent of total billed charges,32.64% of total billed charges,401.82,74,,,percent of total billed charges,74% of total billed charges,401.82,74,,,percent of total billed charges,74% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,363.81,67,,,percent of total billed charges,67% of total billed charges,363.81,67,,,percent of total billed charges,67% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,412.68,76,,,percent of total billed charges,76% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,178.97,32.96,,,percent of total billed charges,32.96% of total billed charges,361.98,105,,,Fee Schedule,pays based on EAPG rates,488.7,90,,,percent of total billed charges,90% of total billed charges,488.7,90,,,percent of total billed charges,90% of total billed charges,344.75,100,,,Fee Schedule,pays based on EAPG rates,481.1,88.6,,,percent of total billed charges,88.6% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,434.4,80,,,percent of total billed charges,80% of total billed charges,434.4,80,,,percent of total billed charges,80% of total billed charges,344.75,100,,,Fee Schedule,pays based on EAPG rates,494.13,91,,,percent of total billed charges,91% of total billed charges,177.24,32.64,,,percent of total billed charges,32.64% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,182.45,33.6,,,percent of total billed charges,33.6% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,499.56,92,,,percent of total billed charges,92% of total billed charges,173.76,499.56,
EXPLOR OF PENETRATE WND ABD/FLANK/BACK,1000101,CDM,450,RC,20102,HCPCS,Outpatient,,,665,565.25,,539.98,81.2,,,percent of total billed charges,81.2% of total billed charges,217.06,32.64,,,percent of total billed charges,32.64% of total billed charges,492.1,74,,,percent of total billed charges,74% of total billed charges,492.1,74,,,percent of total billed charges,74% of total billed charges,212.8,32,,,percent of total billed charges,32% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,212.8,32,,,percent of total billed charges,32% of total billed charges,472.15,71,,,percent of total billed charges,71% of total billed charges,472.15,71,,,percent of total billed charges,71% of total billed charges,445.55,67,,,percent of total billed charges,67% of total billed charges,445.55,67,,,percent of total billed charges,67% of total billed charges,472.15,71,,,percent of total billed charges,71% of total billed charges,505.4,76,,,percent of total billed charges,76% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,219.18,32.96,,,percent of total billed charges,32.96% of total billed charges,361.98,105,,,Fee Schedule,pays based on EAPG rates,598.5,90,,,percent of total billed charges,90% of total billed charges,598.5,90,,,percent of total billed charges,90% of total billed charges,344.75,100,,,Fee Schedule,pays based on EAPG rates,589.19,88.6,,,percent of total billed charges,88.6% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,212.8,32,,,percent of total billed charges,32% of total billed charges,532,80,,,percent of total billed charges,80% of total billed charges,532,80,,,percent of total billed charges,80% of total billed charges,344.75,100,,,Fee Schedule,pays based on EAPG rates,605.15,91,,,percent of total billed charges,91% of total billed charges,217.06,32.64,,,percent of total billed charges,32.64% of total billed charges,212.8,32,,,percent of total billed charges,32% of total billed charges,223.44,33.6,,,percent of total billed charges,33.6% of total billed charges,355.09,103,,,Fee Schedule,pays based on EAPG rates,212.8,32,,,percent of total billed charges,32% of total billed charges,212.8,32,,,percent of total billed charges,32% of total billed charges,611.8,92,,,percent of total billed charges,92% of total billed charges,212.8,611.8,
EXPLORE PNTRATE WND EXTREMITY,1000102,CDM,450,RC,20103,HCPCS,Outpatient,,,674,572.9,,547.29,81.2,,,percent of total billed charges,81.2% of total billed charges,219.99,32.64,,,percent of total billed charges,32.64% of total billed charges,498.76,74,,,percent of total billed charges,74% of total billed charges,498.76,74,,,percent of total billed charges,74% of total billed charges,215.68,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,215.68,32,,,percent of total billed charges,32% of total billed charges,478.54,71,,,percent of total billed charges,71% of total billed charges,478.54,71,,,percent of total billed charges,71% of total billed charges,451.58,67,,,percent of total billed charges,67% of total billed charges,451.58,67,,,percent of total billed charges,67% of total billed charges,478.54,71,,,percent of total billed charges,71% of total billed charges,512.24,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,222.15,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,606.6,90,,,percent of total billed charges,90% of total billed charges,606.6,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,597.16,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,215.68,32,,,percent of total billed charges,32% of total billed charges,539.2,80,,,percent of total billed charges,80% of total billed charges,539.2,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,613.34,91,,,percent of total billed charges,91% of total billed charges,219.99,32.64,,,percent of total billed charges,32.64% of total billed charges,215.68,32,,,percent of total billed charges,32% of total billed charges,226.46,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,215.68,32,,,percent of total billed charges,32% of total billed charges,215.68,32,,,percent of total billed charges,32% of total billed charges,620.08,92,,,percent of total billed charges,92% of total billed charges,147.31,620.08,
RMVL FB WITH MUSCLE/TENDON SHEATH/SIMPLE,1000103,CDM,450,RC,20520,HCPCS,Outpatient,,,318,270.3,,258.22,81.2,,,percent of total billed charges,81.2% of total billed charges,103.8,32.64,,,percent of total billed charges,32.64% of total billed charges,235.32,74,,,percent of total billed charges,74% of total billed charges,235.32,74,,,percent of total billed charges,74% of total billed charges,101.76,32,,,percent of total billed charges,32% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,101.76,32,,,percent of total billed charges,32% of total billed charges,225.78,71,,,percent of total billed charges,71% of total billed charges,225.78,71,,,percent of total billed charges,71% of total billed charges,213.06,67,,,percent of total billed charges,67% of total billed charges,213.06,67,,,percent of total billed charges,67% of total billed charges,225.78,71,,,percent of total billed charges,71% of total billed charges,241.68,76,,,percent of total billed charges,76% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,104.81,32.96,,,percent of total billed charges,32.96% of total billed charges,874.03,105,,,Fee Schedule,pays based on EAPG rates,286.2,90,,,percent of total billed charges,90% of total billed charges,286.2,90,,,percent of total billed charges,90% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,281.75,88.6,,,percent of total billed charges,88.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,101.76,32,,,percent of total billed charges,32% of total billed charges,254.4,80,,,percent of total billed charges,80% of total billed charges,254.4,80,,,percent of total billed charges,80% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,289.38,91,,,percent of total billed charges,91% of total billed charges,103.8,32.64,,,percent of total billed charges,32.64% of total billed charges,101.76,32,,,percent of total billed charges,32% of total billed charges,106.85,33.6,,,percent of total billed charges,33.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,101.76,32,,,percent of total billed charges,32% of total billed charges,101.76,32,,,percent of total billed charges,32% of total billed charges,292.56,92,,,percent of total billed charges,92% of total billed charges,101.76,874.03,
TRIGGER PT INJ 1 OR 2 MUSC GRP,1000357,CDM,450,RC,20552,HCPCS,Outpatient,,,743,631.55,,603.32,81.2,,,percent of total billed charges,81.2% of total billed charges,242.52,32.64,,,percent of total billed charges,32.64% of total billed charges,549.82,74,,,percent of total billed charges,74% of total billed charges,549.82,74,,,percent of total billed charges,74% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,497.81,67,,,percent of total billed charges,67% of total billed charges,497.81,67,,,percent of total billed charges,67% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,564.68,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,244.89,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,668.7,90,,,percent of total billed charges,90% of total billed charges,668.7,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,658.3,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,594.4,80,,,percent of total billed charges,80% of total billed charges,594.4,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,676.13,91,,,percent of total billed charges,91% of total billed charges,242.52,32.64,,,percent of total billed charges,32.64% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,249.65,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,683.56,92,,,percent of total billed charges,92% of total billed charges,107.66,683.56,
TRIGGER PT INJ 3 OR MORE MUSCLES,1000387,CDM,761,RC,20553,HCPCS,Outpatient,,,903,767.55,,733.24,81.2,,,percent of total billed charges,81.2% of total billed charges,294.74,32.64,,,percent of total billed charges,32.64% of total billed charges,668.22,74,,,percent of total billed charges,74% of total billed charges,668.22,74,,,percent of total billed charges,74% of total billed charges,288.96,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,288.96,32,,,percent of total billed charges,32% of total billed charges,641.13,71,,,percent of total billed charges,71% of total billed charges,641.13,71,,,percent of total billed charges,71% of total billed charges,605.01,67,,,percent of total billed charges,67% of total billed charges,605.01,67,,,percent of total billed charges,67% of total billed charges,641.13,71,,,percent of total billed charges,71% of total billed charges,686.28,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,297.63,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,812.7,90,,,percent of total billed charges,90% of total billed charges,812.7,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,800.06,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,288.96,32,,,percent of total billed charges,32% of total billed charges,722.4,80,,,percent of total billed charges,80% of total billed charges,722.4,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,821.73,91,,,percent of total billed charges,91% of total billed charges,294.74,32.64,,,percent of total billed charges,32.64% of total billed charges,288.96,32,,,percent of total billed charges,32% of total billed charges,303.41,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,288.96,32,,,percent of total billed charges,32% of total billed charges,288.96,32,,,percent of total billed charges,32% of total billed charges,830.76,92,,,percent of total billed charges,92% of total billed charges,107.66,830.76,
ARTHROCENTESIS/ASP/INJ SMALL JNT LT,1000448,CDM,761,RC,20600,HCPCS,Outpatient,,,891,757.35,,723.49,81.2,,,percent of total billed charges,81.2% of total billed charges,290.82,32.64,,,percent of total billed charges,32.64% of total billed charges,659.34,74,,,percent of total billed charges,74% of total billed charges,659.34,74,,,percent of total billed charges,74% of total billed charges,285.12,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,285.12,32,,,percent of total billed charges,32% of total billed charges,632.61,71,,,percent of total billed charges,71% of total billed charges,632.61,71,,,percent of total billed charges,71% of total billed charges,596.97,67,,,percent of total billed charges,67% of total billed charges,596.97,67,,,percent of total billed charges,67% of total billed charges,632.61,71,,,percent of total billed charges,71% of total billed charges,677.16,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,293.67,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,801.9,90,,,percent of total billed charges,90% of total billed charges,801.9,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,789.43,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,285.12,32,,,percent of total billed charges,32% of total billed charges,712.8,80,,,percent of total billed charges,80% of total billed charges,712.8,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,810.81,91,,,percent of total billed charges,91% of total billed charges,290.82,32.64,,,percent of total billed charges,32.64% of total billed charges,285.12,32,,,percent of total billed charges,32% of total billed charges,299.38,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,285.12,32,,,percent of total billed charges,32% of total billed charges,285.12,32,,,percent of total billed charges,32% of total billed charges,819.72,92,,,percent of total billed charges,92% of total billed charges,107.66,819.72,
ARTHROCENTESIS/ASP/INJ SMALL JNT RT,1000447,CDM,761,RC,20600,HCPCS,Outpatient,,,891,757.35,,723.49,81.2,,,percent of total billed charges,81.2% of total billed charges,290.82,32.64,,,percent of total billed charges,32.64% of total billed charges,659.34,74,,,percent of total billed charges,74% of total billed charges,659.34,74,,,percent of total billed charges,74% of total billed charges,285.12,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,285.12,32,,,percent of total billed charges,32% of total billed charges,632.61,71,,,percent of total billed charges,71% of total billed charges,632.61,71,,,percent of total billed charges,71% of total billed charges,596.97,67,,,percent of total billed charges,67% of total billed charges,596.97,67,,,percent of total billed charges,67% of total billed charges,632.61,71,,,percent of total billed charges,71% of total billed charges,677.16,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,293.67,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,801.9,90,,,percent of total billed charges,90% of total billed charges,801.9,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,789.43,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,285.12,32,,,percent of total billed charges,32% of total billed charges,712.8,80,,,percent of total billed charges,80% of total billed charges,712.8,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,810.81,91,,,percent of total billed charges,91% of total billed charges,290.82,32.64,,,percent of total billed charges,32.64% of total billed charges,285.12,32,,,percent of total billed charges,32% of total billed charges,299.38,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,285.12,32,,,percent of total billed charges,32% of total billed charges,285.12,32,,,percent of total billed charges,32% of total billed charges,819.72,92,,,percent of total billed charges,92% of total billed charges,107.66,819.72,
DRAIN/INJ INTMD JNT/BURSA WO/US LT,1000377,CDM,450,RC,20605,HCPCS,Outpatient,,,948,805.8,,769.78,81.2,,,percent of total billed charges,81.2% of total billed charges,309.43,32.64,,,percent of total billed charges,32.64% of total billed charges,701.52,74,,,percent of total billed charges,74% of total billed charges,701.52,74,,,percent of total billed charges,74% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,635.16,67,,,percent of total billed charges,67% of total billed charges,635.16,67,,,percent of total billed charges,67% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,720.48,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,312.46,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,853.2,90,,,percent of total billed charges,90% of total billed charges,853.2,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,839.93,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,758.4,80,,,percent of total billed charges,80% of total billed charges,758.4,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,862.68,91,,,percent of total billed charges,91% of total billed charges,309.43,32.64,,,percent of total billed charges,32.64% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,318.53,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,872.16,92,,,percent of total billed charges,92% of total billed charges,107.66,872.16,
DRAIN/INJ INTMD JNT/BURSA WO/US RT,1000378,CDM,450,RC,20605,HCPCS,Outpatient,,,948,805.8,,769.78,81.2,,,percent of total billed charges,81.2% of total billed charges,309.43,32.64,,,percent of total billed charges,32.64% of total billed charges,701.52,74,,,percent of total billed charges,74% of total billed charges,701.52,74,,,percent of total billed charges,74% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,635.16,67,,,percent of total billed charges,67% of total billed charges,635.16,67,,,percent of total billed charges,67% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,720.48,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,312.46,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,853.2,90,,,percent of total billed charges,90% of total billed charges,853.2,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,839.93,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,758.4,80,,,percent of total billed charges,80% of total billed charges,758.4,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,862.68,91,,,percent of total billed charges,91% of total billed charges,309.43,32.64,,,percent of total billed charges,32.64% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,318.53,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,872.16,92,,,percent of total billed charges,92% of total billed charges,107.66,872.16,
DRAIN/INJ INTMD JNT/BURSA WO/US B/L,1000379,CDM,450,RC,20605,HCPCS,Outpatient,,,1422,1208.7,,1154.66,81.2,,,percent of total billed charges,81.2% of total billed charges,464.14,32.64,,,percent of total billed charges,32.64% of total billed charges,1052.28,74,,,percent of total billed charges,74% of total billed charges,1052.28,74,,,percent of total billed charges,74% of total billed charges,455.04,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,455.04,32,,,percent of total billed charges,32% of total billed charges,1009.62,71,,,percent of total billed charges,71% of total billed charges,1009.62,71,,,percent of total billed charges,71% of total billed charges,952.74,67,,,percent of total billed charges,67% of total billed charges,952.74,67,,,percent of total billed charges,67% of total billed charges,1009.62,71,,,percent of total billed charges,71% of total billed charges,1080.72,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,468.69,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,1279.8,90,,,percent of total billed charges,90% of total billed charges,1279.8,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,1259.89,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,455.04,32,,,percent of total billed charges,32% of total billed charges,1137.6,80,,,percent of total billed charges,80% of total billed charges,1137.6,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,1294.02,91,,,percent of total billed charges,91% of total billed charges,464.14,32.64,,,percent of total billed charges,32.64% of total billed charges,455.04,32,,,percent of total billed charges,32% of total billed charges,477.79,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,455.04,32,,,percent of total billed charges,32% of total billed charges,455.04,32,,,percent of total billed charges,32% of total billed charges,1308.24,92,,,percent of total billed charges,92% of total billed charges,107.66,1308.24,
ARTHROCENTESIS/ASP/INJ MJR JNT LT,1000383,CDM,761,RC,20610,HCPCS,Outpatient,,,743,631.55,,603.32,81.2,,,percent of total billed charges,81.2% of total billed charges,242.52,32.64,,,percent of total billed charges,32.64% of total billed charges,549.82,74,,,percent of total billed charges,74% of total billed charges,549.82,74,,,percent of total billed charges,74% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,497.81,67,,,percent of total billed charges,67% of total billed charges,497.81,67,,,percent of total billed charges,67% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,564.68,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,244.89,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,668.7,90,,,percent of total billed charges,90% of total billed charges,668.7,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,658.3,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,594.4,80,,,percent of total billed charges,80% of total billed charges,594.4,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,676.13,91,,,percent of total billed charges,91% of total billed charges,242.52,32.64,,,percent of total billed charges,32.64% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,249.65,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,683.56,92,,,percent of total billed charges,92% of total billed charges,107.66,683.56,
ARTHROCENTESIS/ASP/INJ MJR JNT RT,1000384,CDM,761,RC,20610,HCPCS,Outpatient,,,743,631.55,,603.32,81.2,,,percent of total billed charges,81.2% of total billed charges,242.52,32.64,,,percent of total billed charges,32.64% of total billed charges,549.82,74,,,percent of total billed charges,74% of total billed charges,549.82,74,,,percent of total billed charges,74% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,497.81,67,,,percent of total billed charges,67% of total billed charges,497.81,67,,,percent of total billed charges,67% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,564.68,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,244.89,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,668.7,90,,,percent of total billed charges,90% of total billed charges,668.7,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,658.3,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,594.4,80,,,percent of total billed charges,80% of total billed charges,594.4,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,676.13,91,,,percent of total billed charges,91% of total billed charges,242.52,32.64,,,percent of total billed charges,32.64% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,249.65,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,683.56,92,,,percent of total billed charges,92% of total billed charges,107.66,683.56,
ARTHROCENTESIS/ASP/INJ MJR JNT B/L,1000385,CDM,761,RC,20610,HCPCS,Outpatient,,,1115,947.75,,905.38,81.2,,,percent of total billed charges,81.2% of total billed charges,363.94,32.64,,,percent of total billed charges,32.64% of total billed charges,825.1,74,,,percent of total billed charges,74% of total billed charges,825.1,74,,,percent of total billed charges,74% of total billed charges,356.8,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,356.8,32,,,percent of total billed charges,32% of total billed charges,791.65,71,,,percent of total billed charges,71% of total billed charges,791.65,71,,,percent of total billed charges,71% of total billed charges,747.05,67,,,percent of total billed charges,67% of total billed charges,747.05,67,,,percent of total billed charges,67% of total billed charges,791.65,71,,,percent of total billed charges,71% of total billed charges,847.4,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,367.5,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,987.89,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,356.8,32,,,percent of total billed charges,32% of total billed charges,892,80,,,percent of total billed charges,80% of total billed charges,892,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,1014.65,91,,,percent of total billed charges,91% of total billed charges,363.94,32.64,,,percent of total billed charges,32.64% of total billed charges,356.8,32,,,percent of total billed charges,32% of total billed charges,374.64,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,356.8,32,,,percent of total billed charges,32% of total billed charges,356.8,32,,,percent of total billed charges,32% of total billed charges,1025.8,92,,,percent of total billed charges,92% of total billed charges,107.66,1025.8,
DRAIN/INJ MAJOR JNT/BURSA W/US LT,1000374,CDM,450,RC,20611,HCPCS,Outpatient,,,948,805.8,,769.78,81.2,,,percent of total billed charges,81.2% of total billed charges,309.43,32.64,,,percent of total billed charges,32.64% of total billed charges,701.52,74,,,percent of total billed charges,74% of total billed charges,701.52,74,,,percent of total billed charges,74% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,635.16,67,,,percent of total billed charges,67% of total billed charges,635.16,67,,,percent of total billed charges,67% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,720.48,76,,,percent of total billed charges,76% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,312.46,32.96,,,percent of total billed charges,32.96% of total billed charges,204.75,105,,,Fee Schedule,pays based on EAPG rates,853.2,90,,,percent of total billed charges,90% of total billed charges,853.2,90,,,percent of total billed charges,90% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,839.93,88.6,,,percent of total billed charges,88.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,758.4,80,,,percent of total billed charges,80% of total billed charges,758.4,80,,,percent of total billed charges,80% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,862.68,91,,,percent of total billed charges,91% of total billed charges,309.43,32.64,,,percent of total billed charges,32.64% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,318.53,33.6,,,percent of total billed charges,33.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,872.16,92,,,percent of total billed charges,92% of total billed charges,195,872.16,
DRAIN/INJ MAJOR JNT/BURSA W/US RT,1000375,CDM,450,RC,20611,HCPCS,Outpatient,,,948,805.8,,769.78,81.2,,,percent of total billed charges,81.2% of total billed charges,309.43,32.64,,,percent of total billed charges,32.64% of total billed charges,701.52,74,,,percent of total billed charges,74% of total billed charges,701.52,74,,,percent of total billed charges,74% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,635.16,67,,,percent of total billed charges,67% of total billed charges,635.16,67,,,percent of total billed charges,67% of total billed charges,673.08,71,,,percent of total billed charges,71% of total billed charges,720.48,76,,,percent of total billed charges,76% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,312.46,32.96,,,percent of total billed charges,32.96% of total billed charges,204.75,105,,,Fee Schedule,pays based on EAPG rates,853.2,90,,,percent of total billed charges,90% of total billed charges,853.2,90,,,percent of total billed charges,90% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,839.93,88.6,,,percent of total billed charges,88.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,758.4,80,,,percent of total billed charges,80% of total billed charges,758.4,80,,,percent of total billed charges,80% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,862.68,91,,,percent of total billed charges,91% of total billed charges,309.43,32.64,,,percent of total billed charges,32.64% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,318.53,33.6,,,percent of total billed charges,33.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,303.36,32,,,percent of total billed charges,32% of total billed charges,303.36,32,,,percent of total billed charges,32% of total billed charges,872.16,92,,,percent of total billed charges,92% of total billed charges,195,872.16,
DRAIN/INJ MAJOR JNT/BURSA W/US B/L,1000376,CDM,450,RC,20611,HCPCS,Outpatient,,,1422,1208.7,,1154.66,81.2,,,percent of total billed charges,81.2% of total billed charges,464.14,32.64,,,percent of total billed charges,32.64% of total billed charges,1052.28,74,,,percent of total billed charges,74% of total billed charges,1052.28,74,,,percent of total billed charges,74% of total billed charges,455.04,32,,,percent of total billed charges,32% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,455.04,32,,,percent of total billed charges,32% of total billed charges,1009.62,71,,,percent of total billed charges,71% of total billed charges,1009.62,71,,,percent of total billed charges,71% of total billed charges,952.74,67,,,percent of total billed charges,67% of total billed charges,952.74,67,,,percent of total billed charges,67% of total billed charges,1009.62,71,,,percent of total billed charges,71% of total billed charges,1080.72,76,,,percent of total billed charges,76% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,468.69,32.96,,,percent of total billed charges,32.96% of total billed charges,204.75,105,,,Fee Schedule,pays based on EAPG rates,1279.8,90,,,percent of total billed charges,90% of total billed charges,1279.8,90,,,percent of total billed charges,90% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,1259.89,88.6,,,percent of total billed charges,88.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,455.04,32,,,percent of total billed charges,32% of total billed charges,1137.6,80,,,percent of total billed charges,80% of total billed charges,1137.6,80,,,percent of total billed charges,80% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,1294.02,91,,,percent of total billed charges,91% of total billed charges,464.14,32.64,,,percent of total billed charges,32.64% of total billed charges,455.04,32,,,percent of total billed charges,32% of total billed charges,477.79,33.6,,,percent of total billed charges,33.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,455.04,32,,,percent of total billed charges,32% of total billed charges,455.04,32,,,percent of total billed charges,32% of total billed charges,1308.24,92,,,percent of total billed charges,92% of total billed charges,195,1308.24,
"REPLANTATION, DIGIT, EXCLUDING THUMB",1000267,CDM,450,RC,20822,HCPCS,Outpatient,,,290,246.5,,235.48,81.2,,,percent of total billed charges,81.2% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,1213.76,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,220.4,76,,,percent of total billed charges,76% of total billed charges,1213.76,103,,,Fee Schedule,pays based on EAPG rates,95.58,32.96,,,percent of total billed charges,32.96% of total billed charges,1237.32,105,,,Fee Schedule,pays based on EAPG rates,261,90,,,percent of total billed charges,90% of total billed charges,261,90,,,percent of total billed charges,90% of total billed charges,1178.4,100,,,Fee Schedule,pays based on EAPG rates,256.94,88.6,,,percent of total billed charges,88.6% of total billed charges,1213.76,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,1178.4,100,,,Fee Schedule,pays based on EAPG rates,263.9,91,,,percent of total billed charges,91% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,97.44,33.6,,,percent of total billed charges,33.6% of total billed charges,1213.76,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,266.8,92,,,percent of total billed charges,92% of total billed charges,92.8,1237.32,
CL TX NASAL BONE FX W/O STAB,1000425,CDM,450,RC,21315,HCPCS,Outpatient,,,6319,5371.15,,5131.03,81.2,,,percent of total billed charges,81.2% of total billed charges,2062.52,32.64,,,percent of total billed charges,32.64% of total billed charges,4676.06,74,,,percent of total billed charges,74% of total billed charges,4676.06,74,,,percent of total billed charges,74% of total billed charges,2022.08,32,,,percent of total billed charges,32% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,2022.08,32,,,percent of total billed charges,32% of total billed charges,4486.49,71,,,percent of total billed charges,71% of total billed charges,4486.49,71,,,percent of total billed charges,71% of total billed charges,4233.73,67,,,percent of total billed charges,67% of total billed charges,4233.73,67,,,percent of total billed charges,67% of total billed charges,4486.49,71,,,percent of total billed charges,71% of total billed charges,4802.44,76,,,percent of total billed charges,76% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,2082.74,32.96,,,percent of total billed charges,32.96% of total billed charges,607.78,105,,,Fee Schedule,pays based on EAPG rates,5687.1,90,,,percent of total billed charges,90% of total billed charges,5687.1,90,,,percent of total billed charges,90% of total billed charges,578.84,100,,,Fee Schedule,pays based on EAPG rates,5598.63,88.6,,,percent of total billed charges,88.6% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,2022.08,32,,,percent of total billed charges,32% of total billed charges,5055.2,80,,,percent of total billed charges,80% of total billed charges,5055.2,80,,,percent of total billed charges,80% of total billed charges,578.84,100,,,Fee Schedule,pays based on EAPG rates,5750.29,91,,,percent of total billed charges,91% of total billed charges,2062.52,32.64,,,percent of total billed charges,32.64% of total billed charges,2022.08,32,,,percent of total billed charges,32% of total billed charges,2123.18,33.6,,,percent of total billed charges,33.6% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,2022.08,32,,,percent of total billed charges,32% of total billed charges,2022.08,32,,,percent of total billed charges,32% of total billed charges,5813.48,92,,,percent of total billed charges,92% of total billed charges,578.84,5813.48,
CL TX TEMPOROMANDIBULAR DISLOCATION; INI,1000242,CDM,450,RC,21480,HCPCS,Outpatient,,,100,85,,81.2,81.2,,,percent of total billed charges,81.2% of total billed charges,32.64,32.64,,,percent of total billed charges,32.64% of total billed charges,74,74,,,percent of total billed charges,74% of total billed charges,74,74,,,percent of total billed charges,74% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,32,32,,,percent of total billed charges,32% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,67,67,,,percent of total billed charges,67% of total billed charges,67,67,,,percent of total billed charges,67% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,76,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,32.96,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,88.6,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,32,32,,,percent of total billed charges,32% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,91,91,,,percent of total billed charges,91% of total billed charges,32.64,32.64,,,percent of total billed charges,32.64% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,33.6,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,32,32,,,percent of total billed charges,32% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,92,92,,,percent of total billed charges,92% of total billed charges,32,92,
I&D DEEP ABSC/HEMA SOFT TISSUE NECK/THOR,1000104,CDM,450,RC,21501,HCPCS,Outpatient,,,654,555.9,,531.05,81.2,,,percent of total billed charges,81.2% of total billed charges,213.47,32.64,,,percent of total billed charges,32.64% of total billed charges,483.96,74,,,percent of total billed charges,74% of total billed charges,483.96,74,,,percent of total billed charges,74% of total billed charges,209.28,32,,,percent of total billed charges,32% of total billed charges,1092.79,103,,,Fee Schedule,pays based on EAPG rates,209.28,32,,,percent of total billed charges,32% of total billed charges,464.34,71,,,percent of total billed charges,71% of total billed charges,464.34,71,,,percent of total billed charges,71% of total billed charges,438.18,67,,,percent of total billed charges,67% of total billed charges,438.18,67,,,percent of total billed charges,67% of total billed charges,464.34,71,,,percent of total billed charges,71% of total billed charges,497.04,76,,,percent of total billed charges,76% of total billed charges,1092.79,103,,,Fee Schedule,pays based on EAPG rates,215.56,32.96,,,percent of total billed charges,32.96% of total billed charges,1114.01,105,,,Fee Schedule,pays based on EAPG rates,588.6,90,,,percent of total billed charges,90% of total billed charges,588.6,90,,,percent of total billed charges,90% of total billed charges,1060.96,100,,,Fee Schedule,pays based on EAPG rates,579.44,88.6,,,percent of total billed charges,88.6% of total billed charges,1092.79,103,,,Fee Schedule,pays based on EAPG rates,209.28,32,,,percent of total billed charges,32% of total billed charges,523.2,80,,,percent of total billed charges,80% of total billed charges,523.2,80,,,percent of total billed charges,80% of total billed charges,1060.96,100,,,Fee Schedule,pays based on EAPG rates,595.14,91,,,percent of total billed charges,91% of total billed charges,213.47,32.64,,,percent of total billed charges,32.64% of total billed charges,209.28,32,,,percent of total billed charges,32% of total billed charges,219.74,33.6,,,percent of total billed charges,33.6% of total billed charges,1092.79,103,,,Fee Schedule,pays based on EAPG rates,209.28,32,,,percent of total billed charges,32% of total billed charges,209.28,32,,,percent of total billed charges,32% of total billed charges,601.68,92,,,percent of total billed charges,92% of total billed charges,209.28,1114.01,
CL TX OF CLAVICLE FX W/O MANIPULATION,1000105,CDM,450,RC,23500,HCPCS,Outpatient,,,359,305.15,,291.51,81.2,,,percent of total billed charges,81.2% of total billed charges,117.18,32.64,,,percent of total billed charges,32.64% of total billed charges,265.66,74,,,percent of total billed charges,74% of total billed charges,265.66,74,,,percent of total billed charges,74% of total billed charges,114.88,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,114.88,32,,,percent of total billed charges,32% of total billed charges,254.89,71,,,percent of total billed charges,71% of total billed charges,254.89,71,,,percent of total billed charges,71% of total billed charges,240.53,67,,,percent of total billed charges,67% of total billed charges,240.53,67,,,percent of total billed charges,67% of total billed charges,254.89,71,,,percent of total billed charges,71% of total billed charges,272.84,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,118.33,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,323.1,90,,,percent of total billed charges,90% of total billed charges,323.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,318.07,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,114.88,32,,,percent of total billed charges,32% of total billed charges,287.2,80,,,percent of total billed charges,80% of total billed charges,287.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,326.69,91,,,percent of total billed charges,91% of total billed charges,117.18,32.64,,,percent of total billed charges,32.64% of total billed charges,114.88,32,,,percent of total billed charges,32% of total billed charges,120.62,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,114.88,32,,,percent of total billed charges,32% of total billed charges,114.88,32,,,percent of total billed charges,32% of total billed charges,330.28,92,,,percent of total billed charges,92% of total billed charges,114.88,330.28,
CL TX OF CLAVICLE FX WITH MANIPULATION,1000106,CDM,450,RC,23505,HCPCS,Outpatient,,,629,534.65,,510.75,81.2,,,percent of total billed charges,81.2% of total billed charges,205.31,32.64,,,percent of total billed charges,32.64% of total billed charges,465.46,74,,,percent of total billed charges,74% of total billed charges,465.46,74,,,percent of total billed charges,74% of total billed charges,201.28,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,201.28,32,,,percent of total billed charges,32% of total billed charges,446.59,71,,,percent of total billed charges,71% of total billed charges,446.59,71,,,percent of total billed charges,71% of total billed charges,421.43,67,,,percent of total billed charges,67% of total billed charges,421.43,67,,,percent of total billed charges,67% of total billed charges,446.59,71,,,percent of total billed charges,71% of total billed charges,478.04,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,207.32,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,566.1,90,,,percent of total billed charges,90% of total billed charges,566.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,557.29,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,201.28,32,,,percent of total billed charges,32% of total billed charges,503.2,80,,,percent of total billed charges,80% of total billed charges,503.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,572.39,91,,,percent of total billed charges,91% of total billed charges,205.31,32.64,,,percent of total billed charges,32.64% of total billed charges,201.28,32,,,percent of total billed charges,32% of total billed charges,211.34,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,201.28,32,,,percent of total billed charges,32% of total billed charges,201.28,32,,,percent of total billed charges,32% of total billed charges,578.68,92,,,percent of total billed charges,92% of total billed charges,181.79,578.68,
CL TX PROXIMAL HUMERUS FX W/MANJ,1000236,CDM,450,RC,23605,HCPCS,Outpatient,,,821,697.85,,666.65,81.2,,,percent of total billed charges,81.2% of total billed charges,267.97,32.64,,,percent of total billed charges,32.64% of total billed charges,607.54,74,,,percent of total billed charges,74% of total billed charges,607.54,74,,,percent of total billed charges,74% of total billed charges,262.72,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,262.72,32,,,percent of total billed charges,32% of total billed charges,582.91,71,,,percent of total billed charges,71% of total billed charges,582.91,71,,,percent of total billed charges,71% of total billed charges,550.07,67,,,percent of total billed charges,67% of total billed charges,550.07,67,,,percent of total billed charges,67% of total billed charges,582.91,71,,,percent of total billed charges,71% of total billed charges,623.96,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,270.6,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,738.9,90,,,percent of total billed charges,90% of total billed charges,738.9,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,727.41,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,262.72,32,,,percent of total billed charges,32% of total billed charges,656.8,80,,,percent of total billed charges,80% of total billed charges,656.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,747.11,91,,,percent of total billed charges,91% of total billed charges,267.97,32.64,,,percent of total billed charges,32.64% of total billed charges,262.72,32,,,percent of total billed charges,32% of total billed charges,275.86,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,262.72,32,,,percent of total billed charges,32% of total billed charges,262.72,32,,,percent of total billed charges,32% of total billed charges,755.32,92,,,percent of total billed charges,92% of total billed charges,181.79,755.32,
CL TX SHLDR DISLOCAT W/MAN W/O ANES LT,1000291,CDM,450,RC,23650,HCPCS,Outpatient,,,580,493,,470.96,81.2,,,percent of total billed charges,81.2% of total billed charges,189.31,32.64,,,percent of total billed charges,32.64% of total billed charges,429.2,74,,,percent of total billed charges,74% of total billed charges,429.2,74,,,percent of total billed charges,74% of total billed charges,185.6,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,185.6,32,,,percent of total billed charges,32% of total billed charges,411.8,71,,,percent of total billed charges,71% of total billed charges,411.8,71,,,percent of total billed charges,71% of total billed charges,388.6,67,,,percent of total billed charges,67% of total billed charges,388.6,67,,,percent of total billed charges,67% of total billed charges,411.8,71,,,percent of total billed charges,71% of total billed charges,440.8,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,191.17,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,522,90,,,percent of total billed charges,90% of total billed charges,522,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,513.88,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,185.6,32,,,percent of total billed charges,32% of total billed charges,464,80,,,percent of total billed charges,80% of total billed charges,464,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,527.8,91,,,percent of total billed charges,91% of total billed charges,189.31,32.64,,,percent of total billed charges,32.64% of total billed charges,185.6,32,,,percent of total billed charges,32% of total billed charges,194.88,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,185.6,32,,,percent of total billed charges,32% of total billed charges,185.6,32,,,percent of total billed charges,32% of total billed charges,533.6,92,,,percent of total billed charges,92% of total billed charges,181.79,533.6,
CL TX SHLDR DISLOCAT W/MAN W/O ANES RT,1000290,CDM,450,RC,23650,HCPCS,Outpatient,,,580,493,,470.96,81.2,,,percent of total billed charges,81.2% of total billed charges,189.31,32.64,,,percent of total billed charges,32.64% of total billed charges,429.2,74,,,percent of total billed charges,74% of total billed charges,429.2,74,,,percent of total billed charges,74% of total billed charges,185.6,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,185.6,32,,,percent of total billed charges,32% of total billed charges,411.8,71,,,percent of total billed charges,71% of total billed charges,411.8,71,,,percent of total billed charges,71% of total billed charges,388.6,67,,,percent of total billed charges,67% of total billed charges,388.6,67,,,percent of total billed charges,67% of total billed charges,411.8,71,,,percent of total billed charges,71% of total billed charges,440.8,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,191.17,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,522,90,,,percent of total billed charges,90% of total billed charges,522,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,513.88,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,185.6,32,,,percent of total billed charges,32% of total billed charges,464,80,,,percent of total billed charges,80% of total billed charges,464,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,527.8,91,,,percent of total billed charges,91% of total billed charges,189.31,32.64,,,percent of total billed charges,32.64% of total billed charges,185.6,32,,,percent of total billed charges,32% of total billed charges,194.88,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,185.6,32,,,percent of total billed charges,32% of total billed charges,185.6,32,,,percent of total billed charges,32% of total billed charges,533.6,92,,,percent of total billed charges,92% of total billed charges,181.79,533.6,
CL TX SHLDR DISLOCAT W/MAN W/O ANES B/L,1000239,CDM,450,RC,23650,HCPCS,Outpatient,,,1149,976.65,,932.99,81.2,,,percent of total billed charges,81.2% of total billed charges,375.03,32.64,,,percent of total billed charges,32.64% of total billed charges,850.26,74,,,percent of total billed charges,74% of total billed charges,850.26,74,,,percent of total billed charges,74% of total billed charges,367.68,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,367.68,32,,,percent of total billed charges,32% of total billed charges,815.79,71,,,percent of total billed charges,71% of total billed charges,815.79,71,,,percent of total billed charges,71% of total billed charges,769.83,67,,,percent of total billed charges,67% of total billed charges,769.83,67,,,percent of total billed charges,67% of total billed charges,815.79,71,,,percent of total billed charges,71% of total billed charges,873.24,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,378.71,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1034.1,90,,,percent of total billed charges,90% of total billed charges,1034.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1018.01,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,367.68,32,,,percent of total billed charges,32% of total billed charges,919.2,80,,,percent of total billed charges,80% of total billed charges,919.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1045.59,91,,,percent of total billed charges,91% of total billed charges,375.03,32.64,,,percent of total billed charges,32.64% of total billed charges,367.68,32,,,percent of total billed charges,32% of total billed charges,386.06,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,367.68,32,,,percent of total billed charges,32% of total billed charges,367.68,32,,,percent of total billed charges,32% of total billed charges,1057.08,92,,,percent of total billed charges,92% of total billed charges,181.79,1057.08,
CL TX SHLDR DISLOCAT W/MAN W/ANES LT,1000293,CDM,450,RC,23655,HCPCS,Outpatient,,,782,664.7,,634.98,81.2,,,percent of total billed charges,81.2% of total billed charges,255.24,32.64,,,percent of total billed charges,32.64% of total billed charges,578.68,74,,,percent of total billed charges,74% of total billed charges,578.68,74,,,percent of total billed charges,74% of total billed charges,250.24,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.24,32,,,percent of total billed charges,32% of total billed charges,555.22,71,,,percent of total billed charges,71% of total billed charges,555.22,71,,,percent of total billed charges,71% of total billed charges,523.94,67,,,percent of total billed charges,67% of total billed charges,523.94,67,,,percent of total billed charges,67% of total billed charges,555.22,71,,,percent of total billed charges,71% of total billed charges,594.32,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,257.75,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,703.8,90,,,percent of total billed charges,90% of total billed charges,703.8,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,692.85,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.24,32,,,percent of total billed charges,32% of total billed charges,625.6,80,,,percent of total billed charges,80% of total billed charges,625.6,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,711.62,91,,,percent of total billed charges,91% of total billed charges,255.24,32.64,,,percent of total billed charges,32.64% of total billed charges,250.24,32,,,percent of total billed charges,32% of total billed charges,262.75,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.24,32,,,percent of total billed charges,32% of total billed charges,250.24,32,,,percent of total billed charges,32% of total billed charges,719.44,92,,,percent of total billed charges,92% of total billed charges,250.24,719.44,
CL TX SHLDR DISLOCAT W/MAN W/ANES RT,1000292,CDM,450,RC,23655,HCPCS,Outpatient,,,782,664.7,,634.98,81.2,,,percent of total billed charges,81.2% of total billed charges,255.24,32.64,,,percent of total billed charges,32.64% of total billed charges,578.68,74,,,percent of total billed charges,74% of total billed charges,578.68,74,,,percent of total billed charges,74% of total billed charges,250.24,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.24,32,,,percent of total billed charges,32% of total billed charges,555.22,71,,,percent of total billed charges,71% of total billed charges,555.22,71,,,percent of total billed charges,71% of total billed charges,523.94,67,,,percent of total billed charges,67% of total billed charges,523.94,67,,,percent of total billed charges,67% of total billed charges,555.22,71,,,percent of total billed charges,71% of total billed charges,594.32,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,257.75,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,703.8,90,,,percent of total billed charges,90% of total billed charges,703.8,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,692.85,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.24,32,,,percent of total billed charges,32% of total billed charges,625.6,80,,,percent of total billed charges,80% of total billed charges,625.6,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,711.62,91,,,percent of total billed charges,91% of total billed charges,255.24,32.64,,,percent of total billed charges,32.64% of total billed charges,250.24,32,,,percent of total billed charges,32% of total billed charges,262.75,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.24,32,,,percent of total billed charges,32% of total billed charges,250.24,32,,,percent of total billed charges,32% of total billed charges,719.44,92,,,percent of total billed charges,92% of total billed charges,250.24,719.44,
CL TX SHLDR DISLOCAT W/MAN W/ANES B/L,1000365,CDM,450,RC,23655,HCPCS,Outpatient,,,1173,997.05,,952.48,81.2,,,percent of total billed charges,81.2% of total billed charges,382.87,32.64,,,percent of total billed charges,32.64% of total billed charges,868.02,74,,,percent of total billed charges,74% of total billed charges,868.02,74,,,percent of total billed charges,74% of total billed charges,375.36,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,375.36,32,,,percent of total billed charges,32% of total billed charges,832.83,71,,,percent of total billed charges,71% of total billed charges,832.83,71,,,percent of total billed charges,71% of total billed charges,785.91,67,,,percent of total billed charges,67% of total billed charges,785.91,67,,,percent of total billed charges,67% of total billed charges,832.83,71,,,percent of total billed charges,71% of total billed charges,891.48,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,386.62,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,1055.7,90,,,percent of total billed charges,90% of total billed charges,1055.7,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,1039.28,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,375.36,32,,,percent of total billed charges,32% of total billed charges,938.4,80,,,percent of total billed charges,80% of total billed charges,938.4,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,1067.43,91,,,percent of total billed charges,91% of total billed charges,382.87,32.64,,,percent of total billed charges,32.64% of total billed charges,375.36,32,,,percent of total billed charges,32% of total billed charges,394.13,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,375.36,32,,,percent of total billed charges,32% of total billed charges,375.36,32,,,percent of total billed charges,32% of total billed charges,1079.16,92,,,percent of total billed charges,92% of total billed charges,375.36,1079.16,
"CL TX OF SHOULDER DISLOCAT, WITH FX G LT",1000295,CDM,450,RC,23665,HCPCS,Outpatient,,,721,612.85,,585.45,81.2,,,percent of total billed charges,81.2% of total billed charges,235.33,32.64,,,percent of total billed charges,32.64% of total billed charges,533.54,74,,,percent of total billed charges,74% of total billed charges,533.54,74,,,percent of total billed charges,74% of total billed charges,230.72,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.72,32,,,percent of total billed charges,32% of total billed charges,511.91,71,,,percent of total billed charges,71% of total billed charges,511.91,71,,,percent of total billed charges,71% of total billed charges,483.07,67,,,percent of total billed charges,67% of total billed charges,483.07,67,,,percent of total billed charges,67% of total billed charges,511.91,71,,,percent of total billed charges,71% of total billed charges,547.96,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,237.64,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,648.9,90,,,percent of total billed charges,90% of total billed charges,648.9,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,638.81,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.72,32,,,percent of total billed charges,32% of total billed charges,576.8,80,,,percent of total billed charges,80% of total billed charges,576.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,656.11,91,,,percent of total billed charges,91% of total billed charges,235.33,32.64,,,percent of total billed charges,32.64% of total billed charges,230.72,32,,,percent of total billed charges,32% of total billed charges,242.26,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.72,32,,,percent of total billed charges,32% of total billed charges,230.72,32,,,percent of total billed charges,32% of total billed charges,663.32,92,,,percent of total billed charges,92% of total billed charges,181.79,663.32,
"CL TX OF SHOULDER DISLOCAT, WITH FX G RT",1000294,CDM,450,RC,23665,HCPCS,Outpatient,,,721,612.85,,585.45,81.2,,,percent of total billed charges,81.2% of total billed charges,235.33,32.64,,,percent of total billed charges,32.64% of total billed charges,533.54,74,,,percent of total billed charges,74% of total billed charges,533.54,74,,,percent of total billed charges,74% of total billed charges,230.72,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.72,32,,,percent of total billed charges,32% of total billed charges,511.91,71,,,percent of total billed charges,71% of total billed charges,511.91,71,,,percent of total billed charges,71% of total billed charges,483.07,67,,,percent of total billed charges,67% of total billed charges,483.07,67,,,percent of total billed charges,67% of total billed charges,511.91,71,,,percent of total billed charges,71% of total billed charges,547.96,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,237.64,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,648.9,90,,,percent of total billed charges,90% of total billed charges,648.9,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,638.81,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.72,32,,,percent of total billed charges,32% of total billed charges,576.8,80,,,percent of total billed charges,80% of total billed charges,576.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,656.11,91,,,percent of total billed charges,91% of total billed charges,235.33,32.64,,,percent of total billed charges,32.64% of total billed charges,230.72,32,,,percent of total billed charges,32% of total billed charges,242.26,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.72,32,,,percent of total billed charges,32% of total billed charges,230.72,32,,,percent of total billed charges,32% of total billed charges,663.32,92,,,percent of total billed charges,92% of total billed charges,181.79,663.32,
"CL TX OF SHLDR DISLCT, W NECK FX LT",1000436,CDM,450,RC,23675,HCPCS,Outpatient,,,4748,4035.8,,3855.38,81.2,,,percent of total billed charges,81.2% of total billed charges,1549.75,32.64,,,percent of total billed charges,32.64% of total billed charges,3513.52,74,,,percent of total billed charges,74% of total billed charges,3513.52,74,,,percent of total billed charges,74% of total billed charges,1519.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,1519.36,32,,,percent of total billed charges,32% of total billed charges,3371.08,71,,,percent of total billed charges,71% of total billed charges,3371.08,71,,,percent of total billed charges,71% of total billed charges,3181.16,67,,,percent of total billed charges,67% of total billed charges,3181.16,67,,,percent of total billed charges,67% of total billed charges,3371.08,71,,,percent of total billed charges,71% of total billed charges,3608.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,1564.94,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,4273.2,90,,,percent of total billed charges,90% of total billed charges,4273.2,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,4206.73,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,1519.36,32,,,percent of total billed charges,32% of total billed charges,3798.4,80,,,percent of total billed charges,80% of total billed charges,3798.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,4320.68,91,,,percent of total billed charges,91% of total billed charges,1549.75,32.64,,,percent of total billed charges,32.64% of total billed charges,1519.36,32,,,percent of total billed charges,32% of total billed charges,1595.33,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,1519.36,32,,,percent of total billed charges,32% of total billed charges,1519.36,32,,,percent of total billed charges,32% of total billed charges,4368.16,92,,,percent of total billed charges,92% of total billed charges,181.79,4368.16,
"CL TX OF SHLDR DISLCT, W NECK FX RT",1000435,CDM,450,RC,23675,HCPCS,Outpatient,,,4748,4035.8,,3855.38,81.2,,,percent of total billed charges,81.2% of total billed charges,1549.75,32.64,,,percent of total billed charges,32.64% of total billed charges,3513.52,74,,,percent of total billed charges,74% of total billed charges,3513.52,74,,,percent of total billed charges,74% of total billed charges,1519.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,1519.36,32,,,percent of total billed charges,32% of total billed charges,3371.08,71,,,percent of total billed charges,71% of total billed charges,3371.08,71,,,percent of total billed charges,71% of total billed charges,3181.16,67,,,percent of total billed charges,67% of total billed charges,3181.16,67,,,percent of total billed charges,67% of total billed charges,3371.08,71,,,percent of total billed charges,71% of total billed charges,3608.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,1564.94,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,4273.2,90,,,percent of total billed charges,90% of total billed charges,4273.2,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,4206.73,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,1519.36,32,,,percent of total billed charges,32% of total billed charges,3798.4,80,,,percent of total billed charges,80% of total billed charges,3798.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,4320.68,91,,,percent of total billed charges,91% of total billed charges,1549.75,32.64,,,percent of total billed charges,32.64% of total billed charges,1519.36,32,,,percent of total billed charges,32% of total billed charges,1595.33,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,1519.36,32,,,percent of total billed charges,32% of total billed charges,1519.36,32,,,percent of total billed charges,32% of total billed charges,4368.16,92,,,percent of total billed charges,92% of total billed charges,181.79,4368.16,
CL TX OF HUMERAL SHAFT FX W/O MANIPULATI,1000109,CDM,450,RC,24500,HCPCS,Outpatient,,,556,472.6,,451.47,81.2,,,percent of total billed charges,81.2% of total billed charges,181.48,32.64,,,percent of total billed charges,32.64% of total billed charges,411.44,74,,,percent of total billed charges,74% of total billed charges,411.44,74,,,percent of total billed charges,74% of total billed charges,177.92,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,177.92,32,,,percent of total billed charges,32% of total billed charges,394.76,71,,,percent of total billed charges,71% of total billed charges,394.76,71,,,percent of total billed charges,71% of total billed charges,372.52,67,,,percent of total billed charges,67% of total billed charges,372.52,67,,,percent of total billed charges,67% of total billed charges,394.76,71,,,percent of total billed charges,71% of total billed charges,422.56,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,183.26,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,500.4,90,,,percent of total billed charges,90% of total billed charges,500.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,492.62,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,177.92,32,,,percent of total billed charges,32% of total billed charges,444.8,80,,,percent of total billed charges,80% of total billed charges,444.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,505.96,91,,,percent of total billed charges,91% of total billed charges,181.48,32.64,,,percent of total billed charges,32.64% of total billed charges,177.92,32,,,percent of total billed charges,32% of total billed charges,186.82,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,177.92,32,,,percent of total billed charges,32% of total billed charges,177.92,32,,,percent of total billed charges,32% of total billed charges,511.52,92,,,percent of total billed charges,92% of total billed charges,177.92,511.52,
CL TX HUMERAL SHAFT FX; W/MAN;W W/O SK T,1000238,CDM,450,RC,24505,HCPCS,Outpatient,,,879,747.15,,713.75,81.2,,,percent of total billed charges,81.2% of total billed charges,286.91,32.64,,,percent of total billed charges,32.64% of total billed charges,650.46,74,,,percent of total billed charges,74% of total billed charges,650.46,74,,,percent of total billed charges,74% of total billed charges,281.28,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,281.28,32,,,percent of total billed charges,32% of total billed charges,624.09,71,,,percent of total billed charges,71% of total billed charges,624.09,71,,,percent of total billed charges,71% of total billed charges,588.93,67,,,percent of total billed charges,67% of total billed charges,588.93,67,,,percent of total billed charges,67% of total billed charges,624.09,71,,,percent of total billed charges,71% of total billed charges,668.04,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,289.72,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,791.1,90,,,percent of total billed charges,90% of total billed charges,791.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,778.79,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,281.28,32,,,percent of total billed charges,32% of total billed charges,703.2,80,,,percent of total billed charges,80% of total billed charges,703.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,799.89,91,,,percent of total billed charges,91% of total billed charges,286.91,32.64,,,percent of total billed charges,32.64% of total billed charges,281.28,32,,,percent of total billed charges,32% of total billed charges,295.34,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,281.28,32,,,percent of total billed charges,32% of total billed charges,281.28,32,,,percent of total billed charges,32% of total billed charges,808.68,92,,,percent of total billed charges,92% of total billed charges,181.79,808.68,
CL TX HUM EPIC FX MED/LAT WO MANIPULATIO,1000110,CDM,450,RC,24560,HCPCS,Outpatient,,,484,411.4,,393.01,81.2,,,percent of total billed charges,81.2% of total billed charges,157.98,32.64,,,percent of total billed charges,32.64% of total billed charges,358.16,74,,,percent of total billed charges,74% of total billed charges,358.16,74,,,percent of total billed charges,74% of total billed charges,154.88,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,154.88,32,,,percent of total billed charges,32% of total billed charges,343.64,71,,,percent of total billed charges,71% of total billed charges,343.64,71,,,percent of total billed charges,71% of total billed charges,324.28,67,,,percent of total billed charges,67% of total billed charges,324.28,67,,,percent of total billed charges,67% of total billed charges,343.64,71,,,percent of total billed charges,71% of total billed charges,367.84,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,159.53,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,435.6,90,,,percent of total billed charges,90% of total billed charges,435.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,428.82,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,154.88,32,,,percent of total billed charges,32% of total billed charges,387.2,80,,,percent of total billed charges,80% of total billed charges,387.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,440.44,91,,,percent of total billed charges,91% of total billed charges,157.98,32.64,,,percent of total billed charges,32.64% of total billed charges,154.88,32,,,percent of total billed charges,32% of total billed charges,162.62,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,154.88,32,,,percent of total billed charges,32% of total billed charges,154.88,32,,,percent of total billed charges,32% of total billed charges,445.28,92,,,percent of total billed charges,92% of total billed charges,154.88,445.28,
CL TX OF HUMERAL EPIC FX MED/LAT W/MANIP,1000111,CDM,450,RC,24565,HCPCS,Outpatient,,,949,806.65,,770.59,81.2,,,percent of total billed charges,81.2% of total billed charges,309.75,32.64,,,percent of total billed charges,32.64% of total billed charges,702.26,74,,,percent of total billed charges,74% of total billed charges,702.26,74,,,percent of total billed charges,74% of total billed charges,303.68,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,303.68,32,,,percent of total billed charges,32% of total billed charges,673.79,71,,,percent of total billed charges,71% of total billed charges,673.79,71,,,percent of total billed charges,71% of total billed charges,635.83,67,,,percent of total billed charges,67% of total billed charges,635.83,67,,,percent of total billed charges,67% of total billed charges,673.79,71,,,percent of total billed charges,71% of total billed charges,721.24,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,312.79,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,854.1,90,,,percent of total billed charges,90% of total billed charges,854.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,840.81,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,303.68,32,,,percent of total billed charges,32% of total billed charges,759.2,80,,,percent of total billed charges,80% of total billed charges,759.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,863.59,91,,,percent of total billed charges,91% of total billed charges,309.75,32.64,,,percent of total billed charges,32.64% of total billed charges,303.68,32,,,percent of total billed charges,32% of total billed charges,318.86,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,303.68,32,,,percent of total billed charges,32% of total billed charges,303.68,32,,,percent of total billed charges,32% of total billed charges,873.08,92,,,percent of total billed charges,92% of total billed charges,181.79,873.08,
TX CL ELBOW DISLOCAT; W/O ANESTHESIA LT,1000297,CDM,450,RC,24600,HCPCS,Outpatient,,,719,611.15,,583.83,81.2,,,percent of total billed charges,81.2% of total billed charges,234.68,32.64,,,percent of total billed charges,32.64% of total billed charges,532.06,74,,,percent of total billed charges,74% of total billed charges,532.06,74,,,percent of total billed charges,74% of total billed charges,230.08,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.08,32,,,percent of total billed charges,32% of total billed charges,510.49,71,,,percent of total billed charges,71% of total billed charges,510.49,71,,,percent of total billed charges,71% of total billed charges,481.73,67,,,percent of total billed charges,67% of total billed charges,481.73,67,,,percent of total billed charges,67% of total billed charges,510.49,71,,,percent of total billed charges,71% of total billed charges,546.44,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,236.98,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,647.1,90,,,percent of total billed charges,90% of total billed charges,647.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,637.03,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.08,32,,,percent of total billed charges,32% of total billed charges,575.2,80,,,percent of total billed charges,80% of total billed charges,575.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,654.29,91,,,percent of total billed charges,91% of total billed charges,234.68,32.64,,,percent of total billed charges,32.64% of total billed charges,230.08,32,,,percent of total billed charges,32% of total billed charges,241.58,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.08,32,,,percent of total billed charges,32% of total billed charges,230.08,32,,,percent of total billed charges,32% of total billed charges,661.48,92,,,percent of total billed charges,92% of total billed charges,181.79,661.48,
TX CL ELBOW DISLOCAT; W/O ANESTHESIA RT,1000296,CDM,450,RC,24600,HCPCS,Outpatient,,,719,611.15,,583.83,81.2,,,percent of total billed charges,81.2% of total billed charges,234.68,32.64,,,percent of total billed charges,32.64% of total billed charges,532.06,74,,,percent of total billed charges,74% of total billed charges,532.06,74,,,percent of total billed charges,74% of total billed charges,230.08,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.08,32,,,percent of total billed charges,32% of total billed charges,510.49,71,,,percent of total billed charges,71% of total billed charges,510.49,71,,,percent of total billed charges,71% of total billed charges,481.73,67,,,percent of total billed charges,67% of total billed charges,481.73,67,,,percent of total billed charges,67% of total billed charges,510.49,71,,,percent of total billed charges,71% of total billed charges,546.44,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,236.98,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,647.1,90,,,percent of total billed charges,90% of total billed charges,647.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,637.03,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.08,32,,,percent of total billed charges,32% of total billed charges,575.2,80,,,percent of total billed charges,80% of total billed charges,575.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,654.29,91,,,percent of total billed charges,91% of total billed charges,234.68,32.64,,,percent of total billed charges,32.64% of total billed charges,230.08,32,,,percent of total billed charges,32% of total billed charges,241.58,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,230.08,32,,,percent of total billed charges,32% of total billed charges,230.08,32,,,percent of total billed charges,32% of total billed charges,661.48,92,,,percent of total billed charges,92% of total billed charges,181.79,661.48,
CL TX ELBOW DSLCT W/ ANESTH LT,1000422,CDM,450,RC,24605,HCPCS,Outpatient,,,6349,5396.65,,5155.39,81.2,,,percent of total billed charges,81.2% of total billed charges,2072.31,32.64,,,percent of total billed charges,32.64% of total billed charges,4698.26,74,,,percent of total billed charges,74% of total billed charges,4698.26,74,,,percent of total billed charges,74% of total billed charges,2031.68,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,2031.68,32,,,percent of total billed charges,32% of total billed charges,4507.79,71,,,percent of total billed charges,71% of total billed charges,4507.79,71,,,percent of total billed charges,71% of total billed charges,4253.83,67,,,percent of total billed charges,67% of total billed charges,4253.83,67,,,percent of total billed charges,67% of total billed charges,4507.79,71,,,percent of total billed charges,71% of total billed charges,4825.24,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,2092.63,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,5714.1,90,,,percent of total billed charges,90% of total billed charges,5714.1,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,5625.21,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,2031.68,32,,,percent of total billed charges,32% of total billed charges,5079.2,80,,,percent of total billed charges,80% of total billed charges,5079.2,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,5777.59,91,,,percent of total billed charges,91% of total billed charges,2072.31,32.64,,,percent of total billed charges,32.64% of total billed charges,2031.68,32,,,percent of total billed charges,32% of total billed charges,2133.26,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,2031.68,32,,,percent of total billed charges,32% of total billed charges,2031.68,32,,,percent of total billed charges,32% of total billed charges,5841.08,92,,,percent of total billed charges,92% of total billed charges,508.02,5841.08,
CL TX ELBOW DSLCT W/ ANESTH RT,1000423,CDM,450,RC,24605,HCPCS,Outpatient,,,6349,5396.65,,5155.39,81.2,,,percent of total billed charges,81.2% of total billed charges,2072.31,32.64,,,percent of total billed charges,32.64% of total billed charges,4698.26,74,,,percent of total billed charges,74% of total billed charges,4698.26,74,,,percent of total billed charges,74% of total billed charges,2031.68,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,2031.68,32,,,percent of total billed charges,32% of total billed charges,4507.79,71,,,percent of total billed charges,71% of total billed charges,4507.79,71,,,percent of total billed charges,71% of total billed charges,4253.83,67,,,percent of total billed charges,67% of total billed charges,4253.83,67,,,percent of total billed charges,67% of total billed charges,4507.79,71,,,percent of total billed charges,71% of total billed charges,4825.24,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,2092.63,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,5714.1,90,,,percent of total billed charges,90% of total billed charges,5714.1,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,5625.21,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,2031.68,32,,,percent of total billed charges,32% of total billed charges,5079.2,80,,,percent of total billed charges,80% of total billed charges,5079.2,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,5777.59,91,,,percent of total billed charges,91% of total billed charges,2072.31,32.64,,,percent of total billed charges,32.64% of total billed charges,2031.68,32,,,percent of total billed charges,32% of total billed charges,2133.26,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,2031.68,32,,,percent of total billed charges,32% of total billed charges,2031.68,32,,,percent of total billed charges,32% of total billed charges,5841.08,92,,,percent of total billed charges,92% of total billed charges,508.02,5841.08,
CL TX PRX END ULNA W/DS RD HEAD W/MAN LT,1000299,CDM,450,RC,24620,HCPCS,Outpatient,,,1173,997.05,,952.48,81.2,,,percent of total billed charges,81.2% of total billed charges,382.87,32.64,,,percent of total billed charges,32.64% of total billed charges,868.02,74,,,percent of total billed charges,74% of total billed charges,868.02,74,,,percent of total billed charges,74% of total billed charges,375.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,375.36,32,,,percent of total billed charges,32% of total billed charges,832.83,71,,,percent of total billed charges,71% of total billed charges,832.83,71,,,percent of total billed charges,71% of total billed charges,785.91,67,,,percent of total billed charges,67% of total billed charges,785.91,67,,,percent of total billed charges,67% of total billed charges,832.83,71,,,percent of total billed charges,71% of total billed charges,891.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,386.62,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1055.7,90,,,percent of total billed charges,90% of total billed charges,1055.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1039.28,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,375.36,32,,,percent of total billed charges,32% of total billed charges,938.4,80,,,percent of total billed charges,80% of total billed charges,938.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1067.43,91,,,percent of total billed charges,91% of total billed charges,382.87,32.64,,,percent of total billed charges,32.64% of total billed charges,375.36,32,,,percent of total billed charges,32% of total billed charges,394.13,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,375.36,32,,,percent of total billed charges,32% of total billed charges,375.36,32,,,percent of total billed charges,32% of total billed charges,1079.16,92,,,percent of total billed charges,92% of total billed charges,181.79,1079.16,
CL TX PRX END ULNA W/DS RD HEAD W/MAN RT,1000298,CDM,450,RC,24620,HCPCS,Outpatient,,,1173,997.05,,952.48,81.2,,,percent of total billed charges,81.2% of total billed charges,382.87,32.64,,,percent of total billed charges,32.64% of total billed charges,868.02,74,,,percent of total billed charges,74% of total billed charges,868.02,74,,,percent of total billed charges,74% of total billed charges,375.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,375.36,32,,,percent of total billed charges,32% of total billed charges,832.83,71,,,percent of total billed charges,71% of total billed charges,832.83,71,,,percent of total billed charges,71% of total billed charges,785.91,67,,,percent of total billed charges,67% of total billed charges,785.91,67,,,percent of total billed charges,67% of total billed charges,832.83,71,,,percent of total billed charges,71% of total billed charges,891.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,386.62,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1055.7,90,,,percent of total billed charges,90% of total billed charges,1055.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1039.28,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,375.36,32,,,percent of total billed charges,32% of total billed charges,938.4,80,,,percent of total billed charges,80% of total billed charges,938.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1067.43,91,,,percent of total billed charges,91% of total billed charges,382.87,32.64,,,percent of total billed charges,32.64% of total billed charges,375.36,32,,,percent of total billed charges,32% of total billed charges,394.13,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,375.36,32,,,percent of total billed charges,32% of total billed charges,375.36,32,,,percent of total billed charges,32% of total billed charges,1079.16,92,,,percent of total billed charges,92% of total billed charges,181.79,1079.16,
"CL TX RAD HD SBLXTN CHILD,NM ELB W/MANIP",1000113,CDM,450,RC,24640,HCPCS,Outpatient,,,204,173.4,,165.65,81.2,,,percent of total billed charges,81.2% of total billed charges,66.59,32.64,,,percent of total billed charges,32.64% of total billed charges,150.96,74,,,percent of total billed charges,74% of total billed charges,150.96,74,,,percent of total billed charges,74% of total billed charges,65.28,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,65.28,32,,,percent of total billed charges,32% of total billed charges,144.84,71,,,percent of total billed charges,71% of total billed charges,144.84,71,,,percent of total billed charges,71% of total billed charges,136.68,67,,,percent of total billed charges,67% of total billed charges,136.68,67,,,percent of total billed charges,67% of total billed charges,144.84,71,,,percent of total billed charges,71% of total billed charges,155.04,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,67.24,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,183.6,90,,,percent of total billed charges,90% of total billed charges,183.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,180.74,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,65.28,32,,,percent of total billed charges,32% of total billed charges,163.2,80,,,percent of total billed charges,80% of total billed charges,163.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,185.64,91,,,percent of total billed charges,91% of total billed charges,66.59,32.64,,,percent of total billed charges,32.64% of total billed charges,65.28,32,,,percent of total billed charges,32% of total billed charges,68.54,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,65.28,32,,,percent of total billed charges,32% of total billed charges,65.28,32,,,percent of total billed charges,32% of total billed charges,187.68,92,,,percent of total billed charges,92% of total billed charges,65.28,190.88,
"CL TX RAD HD SBLXTN CHILD,NM ELB W/MANIP",1000356,CDM,450,RC,24640,HCPCS,Outpatient,,,204,173.4,,165.65,81.2,,,percent of total billed charges,81.2% of total billed charges,66.59,32.64,,,percent of total billed charges,32.64% of total billed charges,150.96,74,,,percent of total billed charges,74% of total billed charges,150.96,74,,,percent of total billed charges,74% of total billed charges,65.28,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,65.28,32,,,percent of total billed charges,32% of total billed charges,144.84,71,,,percent of total billed charges,71% of total billed charges,144.84,71,,,percent of total billed charges,71% of total billed charges,136.68,67,,,percent of total billed charges,67% of total billed charges,136.68,67,,,percent of total billed charges,67% of total billed charges,144.84,71,,,percent of total billed charges,71% of total billed charges,155.04,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,67.24,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,183.6,90,,,percent of total billed charges,90% of total billed charges,183.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,180.74,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,65.28,32,,,percent of total billed charges,32% of total billed charges,163.2,80,,,percent of total billed charges,80% of total billed charges,163.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,185.64,91,,,percent of total billed charges,91% of total billed charges,66.59,32.64,,,percent of total billed charges,32.64% of total billed charges,65.28,32,,,percent of total billed charges,32% of total billed charges,68.54,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,65.28,32,,,percent of total billed charges,32% of total billed charges,65.28,32,,,percent of total billed charges,32% of total billed charges,187.68,92,,,percent of total billed charges,92% of total billed charges,65.28,190.88,
CL TX RADIAL HEAD/NECK FX W/O MANIPULATI,1000114,CDM,450,RC,24650,HCPCS,Outpatient,,,376,319.6,,305.31,81.2,,,percent of total billed charges,81.2% of total billed charges,122.73,32.64,,,percent of total billed charges,32.64% of total billed charges,278.24,74,,,percent of total billed charges,74% of total billed charges,278.24,74,,,percent of total billed charges,74% of total billed charges,120.32,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,120.32,32,,,percent of total billed charges,32% of total billed charges,266.96,71,,,percent of total billed charges,71% of total billed charges,266.96,71,,,percent of total billed charges,71% of total billed charges,251.92,67,,,percent of total billed charges,67% of total billed charges,251.92,67,,,percent of total billed charges,67% of total billed charges,266.96,71,,,percent of total billed charges,71% of total billed charges,285.76,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,123.93,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,338.4,90,,,percent of total billed charges,90% of total billed charges,338.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,333.14,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,120.32,32,,,percent of total billed charges,32% of total billed charges,300.8,80,,,percent of total billed charges,80% of total billed charges,300.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,342.16,91,,,percent of total billed charges,91% of total billed charges,122.73,32.64,,,percent of total billed charges,32.64% of total billed charges,120.32,32,,,percent of total billed charges,32% of total billed charges,126.34,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,120.32,32,,,percent of total billed charges,32% of total billed charges,120.32,32,,,percent of total billed charges,32% of total billed charges,345.92,92,,,percent of total billed charges,92% of total billed charges,120.32,345.92,
CL TX RAD HEAD/NECK FX WITH MANIPULATION,1000115,CDM,450,RC,24655,HCPCS,Outpatient,,,755,641.75,,613.06,81.2,,,percent of total billed charges,81.2% of total billed charges,246.43,32.64,,,percent of total billed charges,32.64% of total billed charges,558.7,74,,,percent of total billed charges,74% of total billed charges,558.7,74,,,percent of total billed charges,74% of total billed charges,241.6,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,241.6,32,,,percent of total billed charges,32% of total billed charges,536.05,71,,,percent of total billed charges,71% of total billed charges,536.05,71,,,percent of total billed charges,71% of total billed charges,505.85,67,,,percent of total billed charges,67% of total billed charges,505.85,67,,,percent of total billed charges,67% of total billed charges,536.05,71,,,percent of total billed charges,71% of total billed charges,573.8,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,248.85,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,679.5,90,,,percent of total billed charges,90% of total billed charges,679.5,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,668.93,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,241.6,32,,,percent of total billed charges,32% of total billed charges,604,80,,,percent of total billed charges,80% of total billed charges,604,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,687.05,91,,,percent of total billed charges,91% of total billed charges,246.43,32.64,,,percent of total billed charges,32.64% of total billed charges,241.6,32,,,percent of total billed charges,32% of total billed charges,253.68,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,241.6,32,,,percent of total billed charges,32% of total billed charges,241.6,32,,,percent of total billed charges,32% of total billed charges,694.6,92,,,percent of total billed charges,92% of total billed charges,181.79,694.6,
CL TX ULNAR FX PROX WITHOUT MANIPULATION,1000116,CDM,450,RC,24670,HCPCS,Outpatient,,,437,371.45,,354.84,81.2,,,percent of total billed charges,81.2% of total billed charges,142.64,32.64,,,percent of total billed charges,32.64% of total billed charges,323.38,74,,,percent of total billed charges,74% of total billed charges,323.38,74,,,percent of total billed charges,74% of total billed charges,139.84,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,139.84,32,,,percent of total billed charges,32% of total billed charges,310.27,71,,,percent of total billed charges,71% of total billed charges,310.27,71,,,percent of total billed charges,71% of total billed charges,292.79,67,,,percent of total billed charges,67% of total billed charges,292.79,67,,,percent of total billed charges,67% of total billed charges,310.27,71,,,percent of total billed charges,71% of total billed charges,332.12,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,144.04,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,393.3,90,,,percent of total billed charges,90% of total billed charges,393.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,387.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,139.84,32,,,percent of total billed charges,32% of total billed charges,349.6,80,,,percent of total billed charges,80% of total billed charges,349.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,397.67,91,,,percent of total billed charges,91% of total billed charges,142.64,32.64,,,percent of total billed charges,32.64% of total billed charges,139.84,32,,,percent of total billed charges,32% of total billed charges,146.83,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,139.84,32,,,percent of total billed charges,32% of total billed charges,139.84,32,,,percent of total billed charges,32% of total billed charges,402.04,92,,,percent of total billed charges,92% of total billed charges,139.84,402.04,
CL TX ULNAR FX FX PROXIMAL W/MANIP RT,1000117,CDM,450,RC,24675,HCPCS,Outpatient,,,809,687.65,,656.91,81.2,,,percent of total billed charges,81.2% of total billed charges,264.06,32.64,,,percent of total billed charges,32.64% of total billed charges,598.66,74,,,percent of total billed charges,74% of total billed charges,598.66,74,,,percent of total billed charges,74% of total billed charges,258.88,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,258.88,32,,,percent of total billed charges,32% of total billed charges,574.39,71,,,percent of total billed charges,71% of total billed charges,574.39,71,,,percent of total billed charges,71% of total billed charges,542.03,67,,,percent of total billed charges,67% of total billed charges,542.03,67,,,percent of total billed charges,67% of total billed charges,574.39,71,,,percent of total billed charges,71% of total billed charges,614.84,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.65,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,728.1,90,,,percent of total billed charges,90% of total billed charges,728.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,716.77,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,258.88,32,,,percent of total billed charges,32% of total billed charges,647.2,80,,,percent of total billed charges,80% of total billed charges,647.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,736.19,91,,,percent of total billed charges,91% of total billed charges,264.06,32.64,,,percent of total billed charges,32.64% of total billed charges,258.88,32,,,percent of total billed charges,32% of total billed charges,271.82,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,258.88,32,,,percent of total billed charges,32% of total billed charges,258.88,32,,,percent of total billed charges,32% of total billed charges,744.28,92,,,percent of total billed charges,92% of total billed charges,181.79,744.28,
CL TX RADIAL SHAFT FX WITHOUT MANIPULATI,1000118,CDM,450,RC,25500,HCPCS,Outpatient,,,424,360.4,,344.29,81.2,,,percent of total billed charges,81.2% of total billed charges,138.39,32.64,,,percent of total billed charges,32.64% of total billed charges,313.76,74,,,percent of total billed charges,74% of total billed charges,313.76,74,,,percent of total billed charges,74% of total billed charges,135.68,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,135.68,32,,,percent of total billed charges,32% of total billed charges,301.04,71,,,percent of total billed charges,71% of total billed charges,301.04,71,,,percent of total billed charges,71% of total billed charges,284.08,67,,,percent of total billed charges,67% of total billed charges,284.08,67,,,percent of total billed charges,67% of total billed charges,301.04,71,,,percent of total billed charges,71% of total billed charges,322.24,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,139.75,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,381.6,90,,,percent of total billed charges,90% of total billed charges,381.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,375.66,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,135.68,32,,,percent of total billed charges,32% of total billed charges,339.2,80,,,percent of total billed charges,80% of total billed charges,339.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,385.84,91,,,percent of total billed charges,91% of total billed charges,138.39,32.64,,,percent of total billed charges,32.64% of total billed charges,135.68,32,,,percent of total billed charges,32% of total billed charges,142.46,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,135.68,32,,,percent of total billed charges,32% of total billed charges,135.68,32,,,percent of total billed charges,32% of total billed charges,390.08,92,,,percent of total billed charges,92% of total billed charges,135.68,390.08,
CL TX RADIAL SHAFT FX WITH MANIPULATION,1000119,CDM,450,RC,25505,HCPCS,Outpatient,,,892,758.2,,724.3,81.2,,,percent of total billed charges,81.2% of total billed charges,291.15,32.64,,,percent of total billed charges,32.64% of total billed charges,660.08,74,,,percent of total billed charges,74% of total billed charges,660.08,74,,,percent of total billed charges,74% of total billed charges,285.44,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,285.44,32,,,percent of total billed charges,32% of total billed charges,633.32,71,,,percent of total billed charges,71% of total billed charges,633.32,71,,,percent of total billed charges,71% of total billed charges,597.64,67,,,percent of total billed charges,67% of total billed charges,597.64,67,,,percent of total billed charges,67% of total billed charges,633.32,71,,,percent of total billed charges,71% of total billed charges,677.92,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,294,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,802.8,90,,,percent of total billed charges,90% of total billed charges,802.8,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,790.31,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,285.44,32,,,percent of total billed charges,32% of total billed charges,713.6,80,,,percent of total billed charges,80% of total billed charges,713.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,811.72,91,,,percent of total billed charges,91% of total billed charges,291.15,32.64,,,percent of total billed charges,32.64% of total billed charges,285.44,32,,,percent of total billed charges,32% of total billed charges,299.71,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,285.44,32,,,percent of total billed charges,32% of total billed charges,285.44,32,,,percent of total billed charges,32% of total billed charges,820.64,92,,,percent of total billed charges,92% of total billed charges,181.79,820.64,
CL TX ULNAR SHAFT FX WO MANIPULATION,1000120,CDM,450,RC,25530,HCPCS,Outpatient,,,362,307.7,,293.94,81.2,,,percent of total billed charges,81.2% of total billed charges,118.16,32.64,,,percent of total billed charges,32.64% of total billed charges,267.88,74,,,percent of total billed charges,74% of total billed charges,267.88,74,,,percent of total billed charges,74% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,242.54,67,,,percent of total billed charges,67% of total billed charges,242.54,67,,,percent of total billed charges,67% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,275.12,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,119.32,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,325.8,90,,,percent of total billed charges,90% of total billed charges,325.8,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,320.73,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,289.6,80,,,percent of total billed charges,80% of total billed charges,289.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,329.42,91,,,percent of total billed charges,91% of total billed charges,118.16,32.64,,,percent of total billed charges,32.64% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,121.63,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,333.04,92,,,percent of total billed charges,92% of total billed charges,115.84,333.04,
CL TX ULNAR SHAFT FX WITH MANIPULATION,1000121,CDM,450,RC,25535,HCPCS,Outpatient,,,881,748.85,,715.37,81.2,,,percent of total billed charges,81.2% of total billed charges,287.56,32.64,,,percent of total billed charges,32.64% of total billed charges,651.94,74,,,percent of total billed charges,74% of total billed charges,651.94,74,,,percent of total billed charges,74% of total billed charges,281.92,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,281.92,32,,,percent of total billed charges,32% of total billed charges,625.51,71,,,percent of total billed charges,71% of total billed charges,625.51,71,,,percent of total billed charges,71% of total billed charges,590.27,67,,,percent of total billed charges,67% of total billed charges,590.27,67,,,percent of total billed charges,67% of total billed charges,625.51,71,,,percent of total billed charges,71% of total billed charges,669.56,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,290.38,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,792.9,90,,,percent of total billed charges,90% of total billed charges,792.9,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,780.57,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,281.92,32,,,percent of total billed charges,32% of total billed charges,704.8,80,,,percent of total billed charges,80% of total billed charges,704.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,801.71,91,,,percent of total billed charges,91% of total billed charges,287.56,32.64,,,percent of total billed charges,32.64% of total billed charges,281.92,32,,,percent of total billed charges,32% of total billed charges,296.02,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,281.92,32,,,percent of total billed charges,32% of total billed charges,281.92,32,,,percent of total billed charges,32% of total billed charges,810.52,92,,,percent of total billed charges,92% of total billed charges,181.79,810.52,
CL TX RADIAL & ULNAR SHAFT FX WO MANIPUL,1000122,CDM,450,RC,25560,HCPCS,Outpatient,,,423,359.55,,343.48,81.2,,,percent of total billed charges,81.2% of total billed charges,138.07,32.64,,,percent of total billed charges,32.64% of total billed charges,313.02,74,,,percent of total billed charges,74% of total billed charges,313.02,74,,,percent of total billed charges,74% of total billed charges,135.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,135.36,32,,,percent of total billed charges,32% of total billed charges,300.33,71,,,percent of total billed charges,71% of total billed charges,300.33,71,,,percent of total billed charges,71% of total billed charges,283.41,67,,,percent of total billed charges,67% of total billed charges,283.41,67,,,percent of total billed charges,67% of total billed charges,300.33,71,,,percent of total billed charges,71% of total billed charges,321.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,139.42,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,380.7,90,,,percent of total billed charges,90% of total billed charges,380.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,374.78,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,135.36,32,,,percent of total billed charges,32% of total billed charges,338.4,80,,,percent of total billed charges,80% of total billed charges,338.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,384.93,91,,,percent of total billed charges,91% of total billed charges,138.07,32.64,,,percent of total billed charges,32.64% of total billed charges,135.36,32,,,percent of total billed charges,32% of total billed charges,142.13,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,135.36,32,,,percent of total billed charges,32% of total billed charges,135.36,32,,,percent of total billed charges,32% of total billed charges,389.16,92,,,percent of total billed charges,92% of total billed charges,135.36,389.16,
CL TX RADIAL/ULNAR SHAFT FX WITH MAN LT,1000413,CDM,450,RC,25565,HCPCS,Outpatient,,,959,815.15,,778.71,81.2,,,percent of total billed charges,81.2% of total billed charges,313.02,32.64,,,percent of total billed charges,32.64% of total billed charges,709.66,74,,,percent of total billed charges,74% of total billed charges,709.66,74,,,percent of total billed charges,74% of total billed charges,306.88,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.88,32,,,percent of total billed charges,32% of total billed charges,680.89,71,,,percent of total billed charges,71% of total billed charges,680.89,71,,,percent of total billed charges,71% of total billed charges,642.53,67,,,percent of total billed charges,67% of total billed charges,642.53,67,,,percent of total billed charges,67% of total billed charges,680.89,71,,,percent of total billed charges,71% of total billed charges,728.84,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,316.09,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,863.1,90,,,percent of total billed charges,90% of total billed charges,863.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,849.67,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.88,32,,,percent of total billed charges,32% of total billed charges,767.2,80,,,percent of total billed charges,80% of total billed charges,767.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,872.69,91,,,percent of total billed charges,91% of total billed charges,313.02,32.64,,,percent of total billed charges,32.64% of total billed charges,306.88,32,,,percent of total billed charges,32% of total billed charges,322.22,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.88,32,,,percent of total billed charges,32% of total billed charges,306.88,32,,,percent of total billed charges,32% of total billed charges,882.28,92,,,percent of total billed charges,92% of total billed charges,181.79,882.28,
CL TX RADIAL/ULNAR SHAFT FX WITH MAN RT,1000412,CDM,450,RC,25565,HCPCS,Outpatient,,,959,815.15,,778.71,81.2,,,percent of total billed charges,81.2% of total billed charges,313.02,32.64,,,percent of total billed charges,32.64% of total billed charges,709.66,74,,,percent of total billed charges,74% of total billed charges,709.66,74,,,percent of total billed charges,74% of total billed charges,306.88,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.88,32,,,percent of total billed charges,32% of total billed charges,680.89,71,,,percent of total billed charges,71% of total billed charges,680.89,71,,,percent of total billed charges,71% of total billed charges,642.53,67,,,percent of total billed charges,67% of total billed charges,642.53,67,,,percent of total billed charges,67% of total billed charges,680.89,71,,,percent of total billed charges,71% of total billed charges,728.84,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,316.09,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,863.1,90,,,percent of total billed charges,90% of total billed charges,863.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,849.67,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.88,32,,,percent of total billed charges,32% of total billed charges,767.2,80,,,percent of total billed charges,80% of total billed charges,767.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,872.69,91,,,percent of total billed charges,91% of total billed charges,313.02,32.64,,,percent of total billed charges,32.64% of total billed charges,306.88,32,,,percent of total billed charges,32% of total billed charges,322.22,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.88,32,,,percent of total billed charges,32% of total billed charges,306.88,32,,,percent of total billed charges,32% of total billed charges,882.28,92,,,percent of total billed charges,92% of total billed charges,181.79,882.28,
CL TX DR FX/EPIPHY SEP/TX FX U STY WO/MA,1000124,CDM,450,RC,25600,HCPCS,Outpatient,,,454,385.9,,368.65,81.2,,,percent of total billed charges,81.2% of total billed charges,148.19,32.64,,,percent of total billed charges,32.64% of total billed charges,335.96,74,,,percent of total billed charges,74% of total billed charges,335.96,74,,,percent of total billed charges,74% of total billed charges,145.28,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,145.28,32,,,percent of total billed charges,32% of total billed charges,322.34,71,,,percent of total billed charges,71% of total billed charges,322.34,71,,,percent of total billed charges,71% of total billed charges,304.18,67,,,percent of total billed charges,67% of total billed charges,304.18,67,,,percent of total billed charges,67% of total billed charges,322.34,71,,,percent of total billed charges,71% of total billed charges,345.04,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,149.64,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,408.6,90,,,percent of total billed charges,90% of total billed charges,408.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,402.24,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,145.28,32,,,percent of total billed charges,32% of total billed charges,363.2,80,,,percent of total billed charges,80% of total billed charges,363.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,413.14,91,,,percent of total billed charges,91% of total billed charges,148.19,32.64,,,percent of total billed charges,32.64% of total billed charges,145.28,32,,,percent of total billed charges,32% of total billed charges,152.54,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,145.28,32,,,percent of total billed charges,32% of total billed charges,145.28,32,,,percent of total billed charges,32% of total billed charges,417.68,92,,,percent of total billed charges,92% of total billed charges,145.28,417.68,
CL TX DRFX/EPIP SEP/FX ULNR STY/W MAN LT,1000125,CDM,450,RC,25605,HCPCS,Outpatient,,,1182,1004.7,,959.78,81.2,,,percent of total billed charges,81.2% of total billed charges,385.8,32.64,,,percent of total billed charges,32.64% of total billed charges,874.68,74,,,percent of total billed charges,74% of total billed charges,874.68,74,,,percent of total billed charges,74% of total billed charges,378.24,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,378.24,32,,,percent of total billed charges,32% of total billed charges,839.22,71,,,percent of total billed charges,71% of total billed charges,839.22,71,,,percent of total billed charges,71% of total billed charges,791.94,67,,,percent of total billed charges,67% of total billed charges,791.94,67,,,percent of total billed charges,67% of total billed charges,839.22,71,,,percent of total billed charges,71% of total billed charges,898.32,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,389.59,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1063.8,90,,,percent of total billed charges,90% of total billed charges,1063.8,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1047.25,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,378.24,32,,,percent of total billed charges,32% of total billed charges,945.6,80,,,percent of total billed charges,80% of total billed charges,945.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1075.62,91,,,percent of total billed charges,91% of total billed charges,385.8,32.64,,,percent of total billed charges,32.64% of total billed charges,378.24,32,,,percent of total billed charges,32% of total billed charges,397.15,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,378.24,32,,,percent of total billed charges,32% of total billed charges,378.24,32,,,percent of total billed charges,32% of total billed charges,1087.44,92,,,percent of total billed charges,92% of total billed charges,181.79,1087.44,
CL TX DRFX/EPIP SEP/FX ULNR STY/W MAN RT,1000279,CDM,450,RC,25605,HCPCS,Outpatient,,,1182,1004.7,,959.78,81.2,,,percent of total billed charges,81.2% of total billed charges,385.8,32.64,,,percent of total billed charges,32.64% of total billed charges,874.68,74,,,percent of total billed charges,74% of total billed charges,874.68,74,,,percent of total billed charges,74% of total billed charges,378.24,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,378.24,32,,,percent of total billed charges,32% of total billed charges,839.22,71,,,percent of total billed charges,71% of total billed charges,839.22,71,,,percent of total billed charges,71% of total billed charges,791.94,67,,,percent of total billed charges,67% of total billed charges,791.94,67,,,percent of total billed charges,67% of total billed charges,839.22,71,,,percent of total billed charges,71% of total billed charges,898.32,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,389.59,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1063.8,90,,,percent of total billed charges,90% of total billed charges,1063.8,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1047.25,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,378.24,32,,,percent of total billed charges,32% of total billed charges,945.6,80,,,percent of total billed charges,80% of total billed charges,945.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1075.62,91,,,percent of total billed charges,91% of total billed charges,385.8,32.64,,,percent of total billed charges,32.64% of total billed charges,378.24,32,,,percent of total billed charges,32% of total billed charges,397.15,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,378.24,32,,,percent of total billed charges,32% of total billed charges,378.24,32,,,percent of total billed charges,32% of total billed charges,1087.44,92,,,percent of total billed charges,92% of total billed charges,181.79,1087.44,
CL TX OF ULNAR STYLOID FX LT,1000126,CDM,450,RC,25650,HCPCS,Outpatient,,,833,708.05,,676.4,81.2,,,percent of total billed charges,81.2% of total billed charges,271.89,32.64,,,percent of total billed charges,32.64% of total billed charges,616.42,74,,,percent of total billed charges,74% of total billed charges,616.42,74,,,percent of total billed charges,74% of total billed charges,266.56,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.56,32,,,percent of total billed charges,32% of total billed charges,591.43,71,,,percent of total billed charges,71% of total billed charges,591.43,71,,,percent of total billed charges,71% of total billed charges,558.11,67,,,percent of total billed charges,67% of total billed charges,558.11,67,,,percent of total billed charges,67% of total billed charges,591.43,71,,,percent of total billed charges,71% of total billed charges,633.08,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,274.56,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,749.7,90,,,percent of total billed charges,90% of total billed charges,749.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,738.04,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.56,32,,,percent of total billed charges,32% of total billed charges,666.4,80,,,percent of total billed charges,80% of total billed charges,666.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,758.03,91,,,percent of total billed charges,91% of total billed charges,271.89,32.64,,,percent of total billed charges,32.64% of total billed charges,266.56,32,,,percent of total billed charges,32% of total billed charges,279.89,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.56,32,,,percent of total billed charges,32% of total billed charges,266.56,32,,,percent of total billed charges,32% of total billed charges,766.36,92,,,percent of total billed charges,92% of total billed charges,181.79,766.36,
CL TX OF ULNAR STYLOID FX RT,1000369,CDM,450,RC,25650,HCPCS,Outpatient,,,833,708.05,,676.4,81.2,,,percent of total billed charges,81.2% of total billed charges,271.89,32.64,,,percent of total billed charges,32.64% of total billed charges,616.42,74,,,percent of total billed charges,74% of total billed charges,616.42,74,,,percent of total billed charges,74% of total billed charges,266.56,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.56,32,,,percent of total billed charges,32% of total billed charges,591.43,71,,,percent of total billed charges,71% of total billed charges,591.43,71,,,percent of total billed charges,71% of total billed charges,558.11,67,,,percent of total billed charges,67% of total billed charges,558.11,67,,,percent of total billed charges,67% of total billed charges,591.43,71,,,percent of total billed charges,71% of total billed charges,633.08,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,274.56,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,749.7,90,,,percent of total billed charges,90% of total billed charges,749.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,738.04,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.56,32,,,percent of total billed charges,32% of total billed charges,666.4,80,,,percent of total billed charges,80% of total billed charges,666.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,758.03,91,,,percent of total billed charges,91% of total billed charges,271.89,32.64,,,percent of total billed charges,32.64% of total billed charges,266.56,32,,,percent of total billed charges,32% of total billed charges,279.89,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.56,32,,,percent of total billed charges,32% of total billed charges,266.56,32,,,percent of total billed charges,32% of total billed charges,766.36,92,,,percent of total billed charges,92% of total billed charges,181.79,766.36,
CL TX OF ULNAR STYLOID FX B/L,1000370,CDM,450,RC,25650,HCPCS,Outpatient,,,1248,1060.8,,1013.38,81.2,,,percent of total billed charges,81.2% of total billed charges,407.35,32.64,,,percent of total billed charges,32.64% of total billed charges,923.52,74,,,percent of total billed charges,74% of total billed charges,923.52,74,,,percent of total billed charges,74% of total billed charges,399.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,399.36,32,,,percent of total billed charges,32% of total billed charges,886.08,71,,,percent of total billed charges,71% of total billed charges,886.08,71,,,percent of total billed charges,71% of total billed charges,836.16,67,,,percent of total billed charges,67% of total billed charges,836.16,67,,,percent of total billed charges,67% of total billed charges,886.08,71,,,percent of total billed charges,71% of total billed charges,948.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,411.34,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1123.2,90,,,percent of total billed charges,90% of total billed charges,1123.2,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1105.73,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,399.36,32,,,percent of total billed charges,32% of total billed charges,998.4,80,,,percent of total billed charges,80% of total billed charges,998.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1135.68,91,,,percent of total billed charges,91% of total billed charges,407.35,32.64,,,percent of total billed charges,32.64% of total billed charges,399.36,32,,,percent of total billed charges,32% of total billed charges,419.33,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,399.36,32,,,percent of total billed charges,32% of total billed charges,399.36,32,,,percent of total billed charges,32% of total billed charges,1148.16,92,,,percent of total billed charges,92% of total billed charges,181.79,1148.16,
CL TX  DISTAL RADIOULNAR DSL W MAN LT,1000420,CDM,450,RC,25675,HCPCS,Outpatient,,,1010,858.5,,820.12,81.2,,,percent of total billed charges,81.2% of total billed charges,329.66,32.64,,,percent of total billed charges,32.64% of total billed charges,747.4,74,,,percent of total billed charges,74% of total billed charges,747.4,74,,,percent of total billed charges,74% of total billed charges,323.2,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,323.2,32,,,percent of total billed charges,32% of total billed charges,717.1,71,,,percent of total billed charges,71% of total billed charges,717.1,71,,,percent of total billed charges,71% of total billed charges,676.7,67,,,percent of total billed charges,67% of total billed charges,676.7,67,,,percent of total billed charges,67% of total billed charges,717.1,71,,,percent of total billed charges,71% of total billed charges,767.6,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,332.9,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,909,90,,,percent of total billed charges,90% of total billed charges,909,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,894.86,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,323.2,32,,,percent of total billed charges,32% of total billed charges,808,80,,,percent of total billed charges,80% of total billed charges,808,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,919.1,91,,,percent of total billed charges,91% of total billed charges,329.66,32.64,,,percent of total billed charges,32.64% of total billed charges,323.2,32,,,percent of total billed charges,32% of total billed charges,339.36,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,323.2,32,,,percent of total billed charges,32% of total billed charges,323.2,32,,,percent of total billed charges,32% of total billed charges,929.2,92,,,percent of total billed charges,92% of total billed charges,181.79,929.2,
CL TX  DISTAL RADIOULNAR DSL W MAN RT,1000421,CDM,450,RC,25675,HCPCS,Outpatient,,,1010,858.5,,820.12,81.2,,,percent of total billed charges,81.2% of total billed charges,329.66,32.64,,,percent of total billed charges,32.64% of total billed charges,747.4,74,,,percent of total billed charges,74% of total billed charges,747.4,74,,,percent of total billed charges,74% of total billed charges,323.2,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,323.2,32,,,percent of total billed charges,32% of total billed charges,717.1,71,,,percent of total billed charges,71% of total billed charges,717.1,71,,,percent of total billed charges,71% of total billed charges,676.7,67,,,percent of total billed charges,67% of total billed charges,676.7,67,,,percent of total billed charges,67% of total billed charges,717.1,71,,,percent of total billed charges,71% of total billed charges,767.6,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,332.9,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,909,90,,,percent of total billed charges,90% of total billed charges,909,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,894.86,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,323.2,32,,,percent of total billed charges,32% of total billed charges,808,80,,,percent of total billed charges,80% of total billed charges,808,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,919.1,91,,,percent of total billed charges,91% of total billed charges,329.66,32.64,,,percent of total billed charges,32.64% of total billed charges,323.2,32,,,percent of total billed charges,32% of total billed charges,339.36,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,323.2,32,,,percent of total billed charges,32% of total billed charges,323.2,32,,,percent of total billed charges,32% of total billed charges,929.2,92,,,percent of total billed charges,92% of total billed charges,181.79,929.2,
DRAINAGE OF FINGER ABSCESS; SIMPLE,1000127,CDM,450,RC,26010,HCPCS,Outpatient,,,264,224.4,,214.37,81.2,,,percent of total billed charges,81.2% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,200.64,76,,,percent of total billed charges,76% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,87.01,32.96,,,percent of total billed charges,32.96% of total billed charges,109.18,105,,,Fee Schedule,pays based on EAPG rates,237.6,90,,,percent of total billed charges,90% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,233.9,88.6,,,percent of total billed charges,88.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,103.98,100,,,Fee Schedule,pays based on EAPG rates,240.24,91,,,percent of total billed charges,91% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,88.7,33.6,,,percent of total billed charges,33.6% of total billed charges,107.1,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,242.88,92,,,percent of total billed charges,92% of total billed charges,84.48,242.88,
DRAINAGE OF FINGER ABSCESS; COMPLICATED,1000255,CDM,450,RC,26011,HCPCS,Outpatient,,,363,308.55,,294.76,81.2,,,percent of total billed charges,81.2% of total billed charges,118.48,32.64,,,percent of total billed charges,32.64% of total billed charges,268.62,74,,,percent of total billed charges,74% of total billed charges,268.62,74,,,percent of total billed charges,74% of total billed charges,116.16,32,,,percent of total billed charges,32% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,116.16,32,,,percent of total billed charges,32% of total billed charges,257.73,71,,,percent of total billed charges,71% of total billed charges,257.73,71,,,percent of total billed charges,71% of total billed charges,243.21,67,,,percent of total billed charges,67% of total billed charges,243.21,67,,,percent of total billed charges,67% of total billed charges,257.73,71,,,percent of total billed charges,71% of total billed charges,275.88,76,,,percent of total billed charges,76% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,119.64,32.96,,,percent of total billed charges,32.96% of total billed charges,378.8,105,,,Fee Schedule,pays based on EAPG rates,326.7,90,,,percent of total billed charges,90% of total billed charges,326.7,90,,,percent of total billed charges,90% of total billed charges,360.76,100,,,Fee Schedule,pays based on EAPG rates,321.62,88.6,,,percent of total billed charges,88.6% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,116.16,32,,,percent of total billed charges,32% of total billed charges,290.4,80,,,percent of total billed charges,80% of total billed charges,290.4,80,,,percent of total billed charges,80% of total billed charges,360.76,100,,,Fee Schedule,pays based on EAPG rates,330.33,91,,,percent of total billed charges,91% of total billed charges,118.48,32.64,,,percent of total billed charges,32.64% of total billed charges,116.16,32,,,percent of total billed charges,32% of total billed charges,121.97,33.6,,,percent of total billed charges,33.6% of total billed charges,371.58,103,,,Fee Schedule,pays based on EAPG rates,116.16,32,,,percent of total billed charges,32% of total billed charges,116.16,32,,,percent of total billed charges,32% of total billed charges,333.96,92,,,percent of total billed charges,92% of total billed charges,116.16,378.8,
"REPAIR, EXTENSOR TENDON, PRIM OR SECOND",1000204,CDM,450,RC,26418,HCPCS,Outpatient,,,754,640.9,,612.25,81.2,,,percent of total billed charges,81.2% of total billed charges,246.11,32.64,,,percent of total billed charges,32.64% of total billed charges,557.96,74,,,percent of total billed charges,74% of total billed charges,557.96,74,,,percent of total billed charges,74% of total billed charges,241.28,32,,,percent of total billed charges,32% of total billed charges,741.28,103,,,Fee Schedule,pays based on EAPG rates,241.28,32,,,percent of total billed charges,32% of total billed charges,535.34,71,,,percent of total billed charges,71% of total billed charges,535.34,71,,,percent of total billed charges,71% of total billed charges,505.18,67,,,percent of total billed charges,67% of total billed charges,505.18,67,,,percent of total billed charges,67% of total billed charges,535.34,71,,,percent of total billed charges,71% of total billed charges,573.04,76,,,percent of total billed charges,76% of total billed charges,741.28,103,,,Fee Schedule,pays based on EAPG rates,248.52,32.96,,,percent of total billed charges,32.96% of total billed charges,755.68,105,,,Fee Schedule,pays based on EAPG rates,678.6,90,,,percent of total billed charges,90% of total billed charges,678.6,90,,,percent of total billed charges,90% of total billed charges,719.69,100,,,Fee Schedule,pays based on EAPG rates,668.04,88.6,,,percent of total billed charges,88.6% of total billed charges,741.28,103,,,Fee Schedule,pays based on EAPG rates,241.28,32,,,percent of total billed charges,32% of total billed charges,603.2,80,,,percent of total billed charges,80% of total billed charges,603.2,80,,,percent of total billed charges,80% of total billed charges,719.69,100,,,Fee Schedule,pays based on EAPG rates,686.14,91,,,percent of total billed charges,91% of total billed charges,246.11,32.64,,,percent of total billed charges,32.64% of total billed charges,241.28,32,,,percent of total billed charges,32% of total billed charges,253.34,33.6,,,percent of total billed charges,33.6% of total billed charges,741.28,103,,,Fee Schedule,pays based on EAPG rates,241.28,32,,,percent of total billed charges,32% of total billed charges,241.28,32,,,percent of total billed charges,32% of total billed charges,693.68,92,,,percent of total billed charges,92% of total billed charges,241.28,755.68,
"OSTEOTOMY; METACARPAL, EACH",1000430,CDM,450,RC,26565,HCPCS,Outpatient,,,9615,8172.75,,7807.38,81.2,,,percent of total billed charges,81.2% of total billed charges,3138.34,32.64,,,percent of total billed charges,32.64% of total billed charges,7115.1,74,,,percent of total billed charges,74% of total billed charges,7115.1,74,,,percent of total billed charges,74% of total billed charges,3076.8,32,,,percent of total billed charges,32% of total billed charges,1213.76,103,,,Fee Schedule,pays based on EAPG rates,3076.8,32,,,percent of total billed charges,32% of total billed charges,6826.65,71,,,percent of total billed charges,71% of total billed charges,6826.65,71,,,percent of total billed charges,71% of total billed charges,6442.05,67,,,percent of total billed charges,67% of total billed charges,6442.05,67,,,percent of total billed charges,67% of total billed charges,6826.65,71,,,percent of total billed charges,71% of total billed charges,7307.4,76,,,percent of total billed charges,76% of total billed charges,1213.76,103,,,Fee Schedule,pays based on EAPG rates,3169.1,32.96,,,percent of total billed charges,32.96% of total billed charges,1237.32,105,,,Fee Schedule,pays based on EAPG rates,8653.5,90,,,percent of total billed charges,90% of total billed charges,8653.5,90,,,percent of total billed charges,90% of total billed charges,1178.4,100,,,Fee Schedule,pays based on EAPG rates,8518.89,88.6,,,percent of total billed charges,88.6% of total billed charges,1213.76,103,,,Fee Schedule,pays based on EAPG rates,3076.8,32,,,percent of total billed charges,32% of total billed charges,7692,80,,,percent of total billed charges,80% of total billed charges,7692,80,,,percent of total billed charges,80% of total billed charges,1178.4,100,,,Fee Schedule,pays based on EAPG rates,8749.65,91,,,percent of total billed charges,91% of total billed charges,3138.34,32.64,,,percent of total billed charges,32.64% of total billed charges,3076.8,32,,,percent of total billed charges,32% of total billed charges,3230.64,33.6,,,percent of total billed charges,33.6% of total billed charges,1213.76,103,,,Fee Schedule,pays based on EAPG rates,3076.8,32,,,percent of total billed charges,32% of total billed charges,3076.8,32,,,percent of total billed charges,32% of total billed charges,8845.8,92,,,percent of total billed charges,92% of total billed charges,1178.4,8845.8,
"CL TX METACARPAL FX, SNGL/WO MANIP EA BN",1000128,CDM,450,RC,26600,HCPCS,Outpatient,,,417,354.45,,338.6,81.2,,,percent of total billed charges,81.2% of total billed charges,136.11,32.64,,,percent of total billed charges,32.64% of total billed charges,308.58,74,,,percent of total billed charges,74% of total billed charges,308.58,74,,,percent of total billed charges,74% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,133.44,32,,,percent of total billed charges,32% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,279.39,67,,,percent of total billed charges,67% of total billed charges,279.39,67,,,percent of total billed charges,67% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,316.92,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,137.44,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,375.3,90,,,percent of total billed charges,90% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,369.46,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,133.44,32,,,percent of total billed charges,32% of total billed charges,333.6,80,,,percent of total billed charges,80% of total billed charges,333.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,379.47,91,,,percent of total billed charges,91% of total billed charges,136.11,32.64,,,percent of total billed charges,32.64% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,140.11,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,133.44,32,,,percent of total billed charges,32% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,383.64,92,,,percent of total billed charges,92% of total billed charges,133.44,383.64,
CL TX METACARPAL FX SING W/MANIP EA BONE,1000129,CDM,450,RC,26605,HCPCS,Outpatient,,,491,417.35,,398.69,81.2,,,percent of total billed charges,81.2% of total billed charges,160.26,32.64,,,percent of total billed charges,32.64% of total billed charges,363.34,74,,,percent of total billed charges,74% of total billed charges,363.34,74,,,percent of total billed charges,74% of total billed charges,157.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,157.12,32,,,percent of total billed charges,32% of total billed charges,348.61,71,,,percent of total billed charges,71% of total billed charges,348.61,71,,,percent of total billed charges,71% of total billed charges,328.97,67,,,percent of total billed charges,67% of total billed charges,328.97,67,,,percent of total billed charges,67% of total billed charges,348.61,71,,,percent of total billed charges,71% of total billed charges,373.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,161.83,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,441.9,90,,,percent of total billed charges,90% of total billed charges,441.9,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,435.03,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,157.12,32,,,percent of total billed charges,32% of total billed charges,392.8,80,,,percent of total billed charges,80% of total billed charges,392.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,446.81,91,,,percent of total billed charges,91% of total billed charges,160.26,32.64,,,percent of total billed charges,32.64% of total billed charges,157.12,32,,,percent of total billed charges,32% of total billed charges,164.98,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,157.12,32,,,percent of total billed charges,32% of total billed charges,157.12,32,,,percent of total billed charges,32% of total billed charges,451.72,92,,,percent of total billed charges,92% of total billed charges,157.12,451.72,
CL TX DISLC THMB MANJ EA W/O ANES,1000441,CDM,450,RC,26670,HCPCS,Outpatient,,,704,598.4,,571.65,81.2,,,percent of total billed charges,81.2% of total billed charges,229.79,32.64,,,percent of total billed charges,32.64% of total billed charges,520.96,74,,,percent of total billed charges,74% of total billed charges,520.96,74,,,percent of total billed charges,74% of total billed charges,225.28,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,225.28,32,,,percent of total billed charges,32% of total billed charges,499.84,71,,,percent of total billed charges,71% of total billed charges,499.84,71,,,percent of total billed charges,71% of total billed charges,471.68,67,,,percent of total billed charges,67% of total billed charges,471.68,67,,,percent of total billed charges,67% of total billed charges,499.84,71,,,percent of total billed charges,71% of total billed charges,535.04,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,232.04,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,633.6,90,,,percent of total billed charges,90% of total billed charges,633.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,623.74,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,225.28,32,,,percent of total billed charges,32% of total billed charges,563.2,80,,,percent of total billed charges,80% of total billed charges,563.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,640.64,91,,,percent of total billed charges,91% of total billed charges,229.79,32.64,,,percent of total billed charges,32.64% of total billed charges,225.28,32,,,percent of total billed charges,32% of total billed charges,236.54,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,225.28,32,,,percent of total billed charges,32% of total billed charges,225.28,32,,,percent of total billed charges,32% of total billed charges,647.68,92,,,percent of total billed charges,92% of total billed charges,181.79,647.68,
CL TX MTACRPOPHALNGL SIN;W MAN;WO ANEST,1000185,CDM,450,RC,26700,HCPCS,Outpatient,,,629,534.65,,510.75,81.2,,,percent of total billed charges,81.2% of total billed charges,205.31,32.64,,,percent of total billed charges,32.64% of total billed charges,465.46,74,,,percent of total billed charges,74% of total billed charges,465.46,74,,,percent of total billed charges,74% of total billed charges,201.28,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,201.28,32,,,percent of total billed charges,32% of total billed charges,446.59,71,,,percent of total billed charges,71% of total billed charges,446.59,71,,,percent of total billed charges,71% of total billed charges,421.43,67,,,percent of total billed charges,67% of total billed charges,421.43,67,,,percent of total billed charges,67% of total billed charges,446.59,71,,,percent of total billed charges,71% of total billed charges,478.04,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,207.32,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,566.1,90,,,percent of total billed charges,90% of total billed charges,566.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,557.29,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,201.28,32,,,percent of total billed charges,32% of total billed charges,503.2,80,,,percent of total billed charges,80% of total billed charges,503.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,572.39,91,,,percent of total billed charges,91% of total billed charges,205.31,32.64,,,percent of total billed charges,32.64% of total billed charges,201.28,32,,,percent of total billed charges,32% of total billed charges,211.34,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,201.28,32,,,percent of total billed charges,32% of total billed charges,201.28,32,,,percent of total billed charges,32% of total billed charges,578.68,92,,,percent of total billed charges,92% of total billed charges,181.79,578.68,
CL TX MTACRPOPHALNGL DSLCT W/MAN ANES,1000263,CDM,450,RC,26705,HCPCS,Outpatient,,,629,534.65,,510.75,81.2,,,percent of total billed charges,81.2% of total billed charges,205.31,32.64,,,percent of total billed charges,32.64% of total billed charges,465.46,74,,,percent of total billed charges,74% of total billed charges,465.46,74,,,percent of total billed charges,74% of total billed charges,201.28,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,201.28,32,,,percent of total billed charges,32% of total billed charges,446.59,71,,,percent of total billed charges,71% of total billed charges,446.59,71,,,percent of total billed charges,71% of total billed charges,421.43,67,,,percent of total billed charges,67% of total billed charges,421.43,67,,,percent of total billed charges,67% of total billed charges,446.59,71,,,percent of total billed charges,71% of total billed charges,478.04,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,207.32,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,566.1,90,,,percent of total billed charges,90% of total billed charges,566.1,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,557.29,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,201.28,32,,,percent of total billed charges,32% of total billed charges,503.2,80,,,percent of total billed charges,80% of total billed charges,503.2,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,572.39,91,,,percent of total billed charges,91% of total billed charges,205.31,32.64,,,percent of total billed charges,32.64% of total billed charges,201.28,32,,,percent of total billed charges,32% of total billed charges,211.34,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,201.28,32,,,percent of total billed charges,32% of total billed charges,201.28,32,,,percent of total billed charges,32% of total billed charges,578.68,92,,,percent of total billed charges,92% of total billed charges,201.28,578.68,
"CL TX PHALANGEAL SHAFT FX,PROXIM W/OMAN",1000434,CDM,450,RC,26720,HCPCS,Outpatient,,,586,498.1,,475.83,81.2,,,percent of total billed charges,81.2% of total billed charges,191.27,32.64,,,percent of total billed charges,32.64% of total billed charges,433.64,74,,,percent of total billed charges,74% of total billed charges,433.64,74,,,percent of total billed charges,74% of total billed charges,187.52,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,187.52,32,,,percent of total billed charges,32% of total billed charges,416.06,71,,,percent of total billed charges,71% of total billed charges,416.06,71,,,percent of total billed charges,71% of total billed charges,392.62,67,,,percent of total billed charges,67% of total billed charges,392.62,67,,,percent of total billed charges,67% of total billed charges,416.06,71,,,percent of total billed charges,71% of total billed charges,445.36,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,193.15,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,527.4,90,,,percent of total billed charges,90% of total billed charges,527.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,519.2,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,187.52,32,,,percent of total billed charges,32% of total billed charges,468.8,80,,,percent of total billed charges,80% of total billed charges,468.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,533.26,91,,,percent of total billed charges,91% of total billed charges,191.27,32.64,,,percent of total billed charges,32.64% of total billed charges,187.52,32,,,percent of total billed charges,32% of total billed charges,196.9,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,187.52,32,,,percent of total billed charges,32% of total billed charges,187.52,32,,,percent of total billed charges,32% of total billed charges,539.12,92,,,percent of total billed charges,92% of total billed charges,181.79,539.12,
"CL TX PHALANGEAL SHAFT FX,PROXIMAL W/MAN",1000216,CDM,450,RC,26725,HCPCS,Outpatient,,,586,498.1,,475.83,81.2,,,percent of total billed charges,81.2% of total billed charges,191.27,32.64,,,percent of total billed charges,32.64% of total billed charges,433.64,74,,,percent of total billed charges,74% of total billed charges,433.64,74,,,percent of total billed charges,74% of total billed charges,187.52,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,187.52,32,,,percent of total billed charges,32% of total billed charges,416.06,71,,,percent of total billed charges,71% of total billed charges,416.06,71,,,percent of total billed charges,71% of total billed charges,392.62,67,,,percent of total billed charges,67% of total billed charges,392.62,67,,,percent of total billed charges,67% of total billed charges,416.06,71,,,percent of total billed charges,71% of total billed charges,445.36,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,193.15,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,527.4,90,,,percent of total billed charges,90% of total billed charges,527.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,519.2,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,187.52,32,,,percent of total billed charges,32% of total billed charges,468.8,80,,,percent of total billed charges,80% of total billed charges,468.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,533.26,91,,,percent of total billed charges,91% of total billed charges,191.27,32.64,,,percent of total billed charges,32.64% of total billed charges,187.52,32,,,percent of total billed charges,32% of total billed charges,196.9,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,187.52,32,,,percent of total billed charges,32% of total billed charges,187.52,32,,,percent of total billed charges,32% of total billed charges,539.12,92,,,percent of total billed charges,92% of total billed charges,181.79,539.12,
CL TX ART FX MTCRPPH OR INTER PHAL W MAN,1000186,CDM,450,RC,26742,HCPCS,Outpatient,,,657,558.45,,533.48,81.2,,,percent of total billed charges,81.2% of total billed charges,214.44,32.64,,,percent of total billed charges,32.64% of total billed charges,486.18,74,,,percent of total billed charges,74% of total billed charges,486.18,74,,,percent of total billed charges,74% of total billed charges,210.24,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,210.24,32,,,percent of total billed charges,32% of total billed charges,466.47,71,,,percent of total billed charges,71% of total billed charges,466.47,71,,,percent of total billed charges,71% of total billed charges,440.19,67,,,percent of total billed charges,67% of total billed charges,440.19,67,,,percent of total billed charges,67% of total billed charges,466.47,71,,,percent of total billed charges,71% of total billed charges,499.32,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,216.55,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,591.3,90,,,percent of total billed charges,90% of total billed charges,591.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,582.1,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,210.24,32,,,percent of total billed charges,32% of total billed charges,525.6,80,,,percent of total billed charges,80% of total billed charges,525.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,597.87,91,,,percent of total billed charges,91% of total billed charges,214.44,32.64,,,percent of total billed charges,32.64% of total billed charges,210.24,32,,,percent of total billed charges,32% of total billed charges,220.75,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,210.24,32,,,percent of total billed charges,32% of total billed charges,210.24,32,,,percent of total billed charges,32% of total billed charges,604.44,92,,,percent of total billed charges,92% of total billed charges,181.79,604.44,
"CL TX DISTAL PHALANGEAL FX, WO MANIPULA",1000130,CDM,450,RC,26750,HCPCS,Outpatient,,,294,249.9,,238.73,81.2,,,percent of total billed charges,81.2% of total billed charges,95.96,32.64,,,percent of total billed charges,32.64% of total billed charges,217.56,74,,,percent of total billed charges,74% of total billed charges,217.56,74,,,percent of total billed charges,74% of total billed charges,94.08,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,94.08,32,,,percent of total billed charges,32% of total billed charges,208.74,71,,,percent of total billed charges,71% of total billed charges,208.74,71,,,percent of total billed charges,71% of total billed charges,196.98,67,,,percent of total billed charges,67% of total billed charges,196.98,67,,,percent of total billed charges,67% of total billed charges,208.74,71,,,percent of total billed charges,71% of total billed charges,223.44,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,96.9,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,264.6,90,,,percent of total billed charges,90% of total billed charges,264.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,260.48,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,94.08,32,,,percent of total billed charges,32% of total billed charges,235.2,80,,,percent of total billed charges,80% of total billed charges,235.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,267.54,91,,,percent of total billed charges,91% of total billed charges,95.96,32.64,,,percent of total billed charges,32.64% of total billed charges,94.08,32,,,percent of total billed charges,32% of total billed charges,98.78,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,94.08,32,,,percent of total billed charges,32% of total billed charges,94.08,32,,,percent of total billed charges,32% of total billed charges,270.48,92,,,percent of total billed charges,92% of total billed charges,94.08,270.48,
CL TX DISTAL PHALANGEAL FX/FNG-THMB WOM,1000131,CDM,450,RC,26755,HCPCS,Outpatient,,,532,452.2,,431.98,81.2,,,percent of total billed charges,81.2% of total billed charges,173.64,32.64,,,percent of total billed charges,32.64% of total billed charges,393.68,74,,,percent of total billed charges,74% of total billed charges,393.68,74,,,percent of total billed charges,74% of total billed charges,170.24,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.24,32,,,percent of total billed charges,32% of total billed charges,377.72,71,,,percent of total billed charges,71% of total billed charges,377.72,71,,,percent of total billed charges,71% of total billed charges,356.44,67,,,percent of total billed charges,67% of total billed charges,356.44,67,,,percent of total billed charges,67% of total billed charges,377.72,71,,,percent of total billed charges,71% of total billed charges,404.32,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,175.35,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,478.8,90,,,percent of total billed charges,90% of total billed charges,478.8,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,471.35,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.24,32,,,percent of total billed charges,32% of total billed charges,425.6,80,,,percent of total billed charges,80% of total billed charges,425.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,484.12,91,,,percent of total billed charges,91% of total billed charges,173.64,32.64,,,percent of total billed charges,32.64% of total billed charges,170.24,32,,,percent of total billed charges,32% of total billed charges,178.75,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.24,32,,,percent of total billed charges,32% of total billed charges,170.24,32,,,percent of total billed charges,32% of total billed charges,489.44,92,,,percent of total billed charges,92% of total billed charges,170.24,489.44,
CL TX IPJ DSLCT SNG WMAN WOA LT 2ND DIGI,1000459,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA LT 2ND TOE,1000469,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA LT 3RD DIGI,1000460,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA LT 3RD TOE,1000470,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA LT 4TH DIGI,1000461,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA LT 4TH TOE,1000471,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA LT 5TH DIGI,1000462,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA LT 5TH TOE,1000472,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA LT GRT TOE,1000473,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA LT THUMB,1000463,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT 2ND DIGI,1000464,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT 2ND TOE,1000474,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT 3RD DIGI,1000465,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT 3RD TOE,1000475,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT 4TH DIGI,1000466,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT 4TH TOE,1000476,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT 5TH DIGI,1000467,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT 5TH TOE,1000477,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT GRT TOE,1000478,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX IPJ DSLCT SNG WMAN WOA RT THUMB,1000468,CDM,450,RC,26770,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,165.12,474.72,
CL TX INTERPHAL JNT DSLCT W/MAN ANES,1000272,CDM,450,RC,26775,HCPCS,Outpatient,,,549,466.65,,445.79,81.2,,,percent of total billed charges,81.2% of total billed charges,179.19,32.64,,,percent of total billed charges,32.64% of total billed charges,406.26,74,,,percent of total billed charges,74% of total billed charges,406.26,74,,,percent of total billed charges,74% of total billed charges,175.68,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,175.68,32,,,percent of total billed charges,32% of total billed charges,389.79,71,,,percent of total billed charges,71% of total billed charges,389.79,71,,,percent of total billed charges,71% of total billed charges,367.83,67,,,percent of total billed charges,67% of total billed charges,367.83,67,,,percent of total billed charges,67% of total billed charges,389.79,71,,,percent of total billed charges,71% of total billed charges,417.24,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,180.95,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,494.1,90,,,percent of total billed charges,90% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,486.41,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,175.68,32,,,percent of total billed charges,32% of total billed charges,439.2,80,,,percent of total billed charges,80% of total billed charges,439.2,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,499.59,91,,,percent of total billed charges,91% of total billed charges,179.19,32.64,,,percent of total billed charges,32.64% of total billed charges,175.68,32,,,percent of total billed charges,32% of total billed charges,184.46,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,175.68,32,,,percent of total billed charges,32% of total billed charges,175.68,32,,,percent of total billed charges,32% of total billed charges,505.08,92,,,percent of total billed charges,92% of total billed charges,175.68,533.42,
OPEN TX OF INTERPHALANGEAL JNT DISLOCATI,1000254,CDM,450,RC,26785,HCPCS,Outpatient,,,1075,913.75,,872.9,81.2,,,percent of total billed charges,81.2% of total billed charges,350.88,32.64,,,percent of total billed charges,32.64% of total billed charges,795.5,74,,,percent of total billed charges,74% of total billed charges,795.5,74,,,percent of total billed charges,74% of total billed charges,344,32,,,percent of total billed charges,32% of total billed charges,2286.28,103,,,Fee Schedule,pays based on EAPG rates,344,32,,,percent of total billed charges,32% of total billed charges,763.25,71,,,percent of total billed charges,71% of total billed charges,763.25,71,,,percent of total billed charges,71% of total billed charges,720.25,67,,,percent of total billed charges,67% of total billed charges,720.25,67,,,percent of total billed charges,67% of total billed charges,763.25,71,,,percent of total billed charges,71% of total billed charges,817,76,,,percent of total billed charges,76% of total billed charges,2286.28,103,,,Fee Schedule,pays based on EAPG rates,354.32,32.96,,,percent of total billed charges,32.96% of total billed charges,2330.67,105,,,Fee Schedule,pays based on EAPG rates,967.5,90,,,percent of total billed charges,90% of total billed charges,967.5,90,,,percent of total billed charges,90% of total billed charges,2219.69,100,,,Fee Schedule,pays based on EAPG rates,952.45,88.6,,,percent of total billed charges,88.6% of total billed charges,2286.28,103,,,Fee Schedule,pays based on EAPG rates,344,32,,,percent of total billed charges,32% of total billed charges,860,80,,,percent of total billed charges,80% of total billed charges,860,80,,,percent of total billed charges,80% of total billed charges,2219.69,100,,,Fee Schedule,pays based on EAPG rates,978.25,91,,,percent of total billed charges,91% of total billed charges,350.88,32.64,,,percent of total billed charges,32.64% of total billed charges,344,32,,,percent of total billed charges,32% of total billed charges,361.2,33.6,,,percent of total billed charges,33.6% of total billed charges,2286.28,103,,,Fee Schedule,pays based on EAPG rates,344,32,,,percent of total billed charges,32% of total billed charges,344,32,,,percent of total billed charges,32% of total billed charges,989,92,,,percent of total billed charges,92% of total billed charges,344,2330.67,
"CL TX PELVIC RING FX DSLOC,DIAST,WO MANI",1000195,CDM,450,RC,27197,HCPCS,Outpatient,,,1025,871.25,,832.3,81.2,,,percent of total billed charges,81.2% of total billed charges,334.56,32.64,,,percent of total billed charges,32.64% of total billed charges,758.5,74,,,percent of total billed charges,74% of total billed charges,758.5,74,,,percent of total billed charges,74% of total billed charges,328,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,328,32,,,percent of total billed charges,32% of total billed charges,727.75,71,,,percent of total billed charges,71% of total billed charges,727.75,71,,,percent of total billed charges,71% of total billed charges,686.75,67,,,percent of total billed charges,67% of total billed charges,686.75,67,,,percent of total billed charges,67% of total billed charges,727.75,71,,,percent of total billed charges,71% of total billed charges,779,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,337.84,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,922.5,90,,,percent of total billed charges,90% of total billed charges,922.5,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,908.15,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,328,32,,,percent of total billed charges,32% of total billed charges,820,80,,,percent of total billed charges,80% of total billed charges,820,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,932.75,91,,,percent of total billed charges,91% of total billed charges,334.56,32.64,,,percent of total billed charges,32.64% of total billed charges,328,32,,,percent of total billed charges,32% of total billed charges,344.4,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,328,32,,,percent of total billed charges,32% of total billed charges,328,32,,,percent of total billed charges,32% of total billed charges,943,92,,,percent of total billed charges,92% of total billed charges,181.79,943,
CL TX ACETABULUM FX WO MANIPULATIONQ,1000133,CDM,450,RC,27220,HCPCS,Outpatient,,,1134,963.9,,920.81,81.2,,,percent of total billed charges,81.2% of total billed charges,370.14,32.64,,,percent of total billed charges,32.64% of total billed charges,839.16,74,,,percent of total billed charges,74% of total billed charges,839.16,74,,,percent of total billed charges,74% of total billed charges,362.88,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,362.88,32,,,percent of total billed charges,32% of total billed charges,805.14,71,,,percent of total billed charges,71% of total billed charges,805.14,71,,,percent of total billed charges,71% of total billed charges,759.78,67,,,percent of total billed charges,67% of total billed charges,759.78,67,,,percent of total billed charges,67% of total billed charges,805.14,71,,,percent of total billed charges,71% of total billed charges,861.84,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,373.77,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1020.6,90,,,percent of total billed charges,90% of total billed charges,1020.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1004.72,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,362.88,32,,,percent of total billed charges,32% of total billed charges,907.2,80,,,percent of total billed charges,80% of total billed charges,907.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1031.94,91,,,percent of total billed charges,91% of total billed charges,370.14,32.64,,,percent of total billed charges,32.64% of total billed charges,362.88,32,,,percent of total billed charges,32% of total billed charges,381.02,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,362.88,32,,,percent of total billed charges,32% of total billed charges,362.88,32,,,percent of total billed charges,32% of total billed charges,1043.28,92,,,percent of total billed charges,92% of total billed charges,181.79,1043.28,
CL TX ACETABULUM FX W/ MAN LT,1000390,CDM,450,RC,27222,HCPCS,Outpatient,,,1026,872.1,,833.11,81.2,,,percent of total billed charges,81.2% of total billed charges,334.89,32.64,,,percent of total billed charges,32.64% of total billed charges,759.24,74,,,percent of total billed charges,74% of total billed charges,759.24,74,,,percent of total billed charges,74% of total billed charges,328.32,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,328.32,32,,,percent of total billed charges,32% of total billed charges,728.46,71,,,percent of total billed charges,71% of total billed charges,728.46,71,,,percent of total billed charges,71% of total billed charges,687.42,67,,,percent of total billed charges,67% of total billed charges,687.42,67,,,percent of total billed charges,67% of total billed charges,728.46,71,,,percent of total billed charges,71% of total billed charges,779.76,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,338.17,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,923.4,90,,,percent of total billed charges,90% of total billed charges,923.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,909.04,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,328.32,32,,,percent of total billed charges,32% of total billed charges,820.8,80,,,percent of total billed charges,80% of total billed charges,820.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,933.66,91,,,percent of total billed charges,91% of total billed charges,334.89,32.64,,,percent of total billed charges,32.64% of total billed charges,328.32,32,,,percent of total billed charges,32% of total billed charges,344.74,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,328.32,32,,,percent of total billed charges,32% of total billed charges,328.32,32,,,percent of total billed charges,32% of total billed charges,943.92,92,,,percent of total billed charges,92% of total billed charges,181.79,943.92,
CL TX ACETABULUM FX W/ MAN RT,1000389,CDM,450,RC,27222,HCPCS,Outpatient,,,1026,872.1,,833.11,81.2,,,percent of total billed charges,81.2% of total billed charges,334.89,32.64,,,percent of total billed charges,32.64% of total billed charges,759.24,74,,,percent of total billed charges,74% of total billed charges,759.24,74,,,percent of total billed charges,74% of total billed charges,328.32,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,328.32,32,,,percent of total billed charges,32% of total billed charges,728.46,71,,,percent of total billed charges,71% of total billed charges,728.46,71,,,percent of total billed charges,71% of total billed charges,687.42,67,,,percent of total billed charges,67% of total billed charges,687.42,67,,,percent of total billed charges,67% of total billed charges,728.46,71,,,percent of total billed charges,71% of total billed charges,779.76,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,338.17,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,923.4,90,,,percent of total billed charges,90% of total billed charges,923.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,909.04,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,328.32,32,,,percent of total billed charges,32% of total billed charges,820.8,80,,,percent of total billed charges,80% of total billed charges,820.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,933.66,91,,,percent of total billed charges,91% of total billed charges,334.89,32.64,,,percent of total billed charges,32.64% of total billed charges,328.32,32,,,percent of total billed charges,32% of total billed charges,344.74,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,328.32,32,,,percent of total billed charges,32% of total billed charges,328.32,32,,,percent of total billed charges,32% of total billed charges,943.92,92,,,percent of total billed charges,92% of total billed charges,181.79,943.92,
CL TX FEMORAL FX PROXIMAL END NECK WO MA,1000134,CDM,450,RC,27230,HCPCS,Outpatient,,,957,813.45,,777.08,81.2,,,percent of total billed charges,81.2% of total billed charges,312.36,32.64,,,percent of total billed charges,32.64% of total billed charges,708.18,74,,,percent of total billed charges,74% of total billed charges,708.18,74,,,percent of total billed charges,74% of total billed charges,306.24,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.24,32,,,percent of total billed charges,32% of total billed charges,679.47,71,,,percent of total billed charges,71% of total billed charges,679.47,71,,,percent of total billed charges,71% of total billed charges,641.19,67,,,percent of total billed charges,67% of total billed charges,641.19,67,,,percent of total billed charges,67% of total billed charges,679.47,71,,,percent of total billed charges,71% of total billed charges,727.32,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,315.43,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,861.3,90,,,percent of total billed charges,90% of total billed charges,861.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,847.9,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.24,32,,,percent of total billed charges,32% of total billed charges,765.6,80,,,percent of total billed charges,80% of total billed charges,765.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,870.87,91,,,percent of total billed charges,91% of total billed charges,312.36,32.64,,,percent of total billed charges,32.64% of total billed charges,306.24,32,,,percent of total billed charges,32% of total billed charges,321.55,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.24,32,,,percent of total billed charges,32% of total billed charges,306.24,32,,,percent of total billed charges,32% of total billed charges,880.44,92,,,percent of total billed charges,92% of total billed charges,181.79,880.44,
CL TX FEML FX W MAN W W/O SKTL TRCT LT,1000381,CDM,450,RC,27232,HCPCS,Outpatient,,,1961,1666.85,,1592.33,81.2,,,percent of total billed charges,81.2% of total billed charges,640.07,32.64,,,percent of total billed charges,32.64% of total billed charges,1451.14,74,,,percent of total billed charges,74% of total billed charges,1451.14,74,,,percent of total billed charges,74% of total billed charges,627.52,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,627.52,32,,,percent of total billed charges,32% of total billed charges,1392.31,71,,,percent of total billed charges,71% of total billed charges,1392.31,71,,,percent of total billed charges,71% of total billed charges,1313.87,67,,,percent of total billed charges,67% of total billed charges,1313.87,67,,,percent of total billed charges,67% of total billed charges,1392.31,71,,,percent of total billed charges,71% of total billed charges,1490.36,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,646.35,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1764.9,90,,,percent of total billed charges,90% of total billed charges,1764.9,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1737.45,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,627.52,32,,,percent of total billed charges,32% of total billed charges,1568.8,80,,,percent of total billed charges,80% of total billed charges,1568.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1784.51,91,,,percent of total billed charges,91% of total billed charges,640.07,32.64,,,percent of total billed charges,32.64% of total billed charges,627.52,32,,,percent of total billed charges,32% of total billed charges,658.9,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,627.52,32,,,percent of total billed charges,32% of total billed charges,627.52,32,,,percent of total billed charges,32% of total billed charges,1804.12,92,,,percent of total billed charges,92% of total billed charges,181.79,1804.12,
CL TX FEML FX W MANIP W W/O SKTL TRCT RT,1000135,CDM,450,RC,27232,HCPCS,Outpatient,,,1961,1666.85,,1592.33,81.2,,,percent of total billed charges,81.2% of total billed charges,640.07,32.64,,,percent of total billed charges,32.64% of total billed charges,1451.14,74,,,percent of total billed charges,74% of total billed charges,1451.14,74,,,percent of total billed charges,74% of total billed charges,627.52,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,627.52,32,,,percent of total billed charges,32% of total billed charges,1392.31,71,,,percent of total billed charges,71% of total billed charges,1392.31,71,,,percent of total billed charges,71% of total billed charges,1313.87,67,,,percent of total billed charges,67% of total billed charges,1313.87,67,,,percent of total billed charges,67% of total billed charges,1392.31,71,,,percent of total billed charges,71% of total billed charges,1490.36,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,646.35,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1764.9,90,,,percent of total billed charges,90% of total billed charges,1764.9,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1737.45,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,627.52,32,,,percent of total billed charges,32% of total billed charges,1568.8,80,,,percent of total billed charges,80% of total billed charges,1568.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1784.51,91,,,percent of total billed charges,91% of total billed charges,640.07,32.64,,,percent of total billed charges,32.64% of total billed charges,627.52,32,,,percent of total billed charges,32% of total billed charges,658.9,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,627.52,32,,,percent of total billed charges,32% of total billed charges,627.52,32,,,percent of total billed charges,32% of total billed charges,1804.12,92,,,percent of total billed charges,92% of total billed charges,181.79,1804.12,
CL TX FEML FX W MAN W W/O SKTL TRCT B/L,1000382,CDM,450,RC,27232,HCPCS,Outpatient,,,2943,2501.55,,2389.72,81.2,,,percent of total billed charges,81.2% of total billed charges,960.6,32.64,,,percent of total billed charges,32.64% of total billed charges,2177.82,74,,,percent of total billed charges,74% of total billed charges,2177.82,74,,,percent of total billed charges,74% of total billed charges,941.76,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,941.76,32,,,percent of total billed charges,32% of total billed charges,2089.53,71,,,percent of total billed charges,71% of total billed charges,2089.53,71,,,percent of total billed charges,71% of total billed charges,1971.81,67,,,percent of total billed charges,67% of total billed charges,1971.81,67,,,percent of total billed charges,67% of total billed charges,2089.53,71,,,percent of total billed charges,71% of total billed charges,2236.68,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,970.01,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,2648.7,90,,,percent of total billed charges,90% of total billed charges,2648.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,2607.5,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,941.76,32,,,percent of total billed charges,32% of total billed charges,2354.4,80,,,percent of total billed charges,80% of total billed charges,2354.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,2678.13,91,,,percent of total billed charges,91% of total billed charges,960.6,32.64,,,percent of total billed charges,32.64% of total billed charges,941.76,32,,,percent of total billed charges,32% of total billed charges,988.85,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,941.76,32,,,percent of total billed charges,32% of total billed charges,941.76,32,,,percent of total billed charges,32% of total billed charges,2707.56,92,,,percent of total billed charges,92% of total billed charges,181.79,2707.56,
CL TX HIP DISLOCAT TRAUMATIC WO ANEST LT,1000301,CDM,450,RC,27250,HCPCS,Outpatient,,,644,547.4,,522.93,81.2,,,percent of total billed charges,81.2% of total billed charges,210.2,32.64,,,percent of total billed charges,32.64% of total billed charges,476.56,74,,,percent of total billed charges,74% of total billed charges,476.56,74,,,percent of total billed charges,74% of total billed charges,206.08,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,206.08,32,,,percent of total billed charges,32% of total billed charges,457.24,71,,,percent of total billed charges,71% of total billed charges,457.24,71,,,percent of total billed charges,71% of total billed charges,431.48,67,,,percent of total billed charges,67% of total billed charges,431.48,67,,,percent of total billed charges,67% of total billed charges,457.24,71,,,percent of total billed charges,71% of total billed charges,489.44,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,212.26,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,579.6,90,,,percent of total billed charges,90% of total billed charges,579.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,570.58,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,206.08,32,,,percent of total billed charges,32% of total billed charges,515.2,80,,,percent of total billed charges,80% of total billed charges,515.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,586.04,91,,,percent of total billed charges,91% of total billed charges,210.2,32.64,,,percent of total billed charges,32.64% of total billed charges,206.08,32,,,percent of total billed charges,32% of total billed charges,216.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,206.08,32,,,percent of total billed charges,32% of total billed charges,206.08,32,,,percent of total billed charges,32% of total billed charges,592.48,92,,,percent of total billed charges,92% of total billed charges,181.79,592.48,
CL TX HIP DISLOCAT TRAUMATIC WO ANEST RT,1000300,CDM,450,RC,27250,HCPCS,Outpatient,,,644,547.4,,522.93,81.2,,,percent of total billed charges,81.2% of total billed charges,210.2,32.64,,,percent of total billed charges,32.64% of total billed charges,476.56,74,,,percent of total billed charges,74% of total billed charges,476.56,74,,,percent of total billed charges,74% of total billed charges,206.08,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,206.08,32,,,percent of total billed charges,32% of total billed charges,457.24,71,,,percent of total billed charges,71% of total billed charges,457.24,71,,,percent of total billed charges,71% of total billed charges,431.48,67,,,percent of total billed charges,67% of total billed charges,431.48,67,,,percent of total billed charges,67% of total billed charges,457.24,71,,,percent of total billed charges,71% of total billed charges,489.44,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,212.26,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,579.6,90,,,percent of total billed charges,90% of total billed charges,579.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,570.58,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,206.08,32,,,percent of total billed charges,32% of total billed charges,515.2,80,,,percent of total billed charges,80% of total billed charges,515.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,586.04,91,,,percent of total billed charges,91% of total billed charges,210.2,32.64,,,percent of total billed charges,32.64% of total billed charges,206.08,32,,,percent of total billed charges,32% of total billed charges,216.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,206.08,32,,,percent of total billed charges,32% of total billed charges,206.08,32,,,percent of total billed charges,32% of total billed charges,592.48,92,,,percent of total billed charges,92% of total billed charges,181.79,592.48,
CL TX HIP DISLOCAT TRAUMATIC W ANEST LT,1000411,CDM,450,RC,27252,HCPCS,Outpatient,,,870,739.5,,706.44,81.2,,,percent of total billed charges,81.2% of total billed charges,283.97,32.64,,,percent of total billed charges,32.64% of total billed charges,643.8,74,,,percent of total billed charges,74% of total billed charges,643.8,74,,,percent of total billed charges,74% of total billed charges,278.4,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,278.4,32,,,percent of total billed charges,32% of total billed charges,617.7,71,,,percent of total billed charges,71% of total billed charges,617.7,71,,,percent of total billed charges,71% of total billed charges,582.9,67,,,percent of total billed charges,67% of total billed charges,582.9,67,,,percent of total billed charges,67% of total billed charges,617.7,71,,,percent of total billed charges,71% of total billed charges,661.2,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,286.75,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,783,90,,,percent of total billed charges,90% of total billed charges,783,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,770.82,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,278.4,32,,,percent of total billed charges,32% of total billed charges,696,80,,,percent of total billed charges,80% of total billed charges,696,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,791.7,91,,,percent of total billed charges,91% of total billed charges,283.97,32.64,,,percent of total billed charges,32.64% of total billed charges,278.4,32,,,percent of total billed charges,32% of total billed charges,292.32,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,278.4,32,,,percent of total billed charges,32% of total billed charges,278.4,32,,,percent of total billed charges,32% of total billed charges,800.4,92,,,percent of total billed charges,92% of total billed charges,278.4,800.4,
CL TX HIP DISLOCAT TRAUMATIC W ANEST RT,1000362,CDM,450,RC,27252,HCPCS,Outpatient,,,870,739.5,,706.44,81.2,,,percent of total billed charges,81.2% of total billed charges,283.97,32.64,,,percent of total billed charges,32.64% of total billed charges,643.8,74,,,percent of total billed charges,74% of total billed charges,643.8,74,,,percent of total billed charges,74% of total billed charges,278.4,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,278.4,32,,,percent of total billed charges,32% of total billed charges,617.7,71,,,percent of total billed charges,71% of total billed charges,617.7,71,,,percent of total billed charges,71% of total billed charges,582.9,67,,,percent of total billed charges,67% of total billed charges,582.9,67,,,percent of total billed charges,67% of total billed charges,617.7,71,,,percent of total billed charges,71% of total billed charges,661.2,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,286.75,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,783,90,,,percent of total billed charges,90% of total billed charges,783,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,770.82,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,278.4,32,,,percent of total billed charges,32% of total billed charges,696,80,,,percent of total billed charges,80% of total billed charges,696,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,791.7,91,,,percent of total billed charges,91% of total billed charges,283.97,32.64,,,percent of total billed charges,32.64% of total billed charges,278.4,32,,,percent of total billed charges,32% of total billed charges,292.32,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,278.4,32,,,percent of total billed charges,32% of total billed charges,278.4,32,,,percent of total billed charges,32% of total billed charges,800.4,92,,,percent of total billed charges,92% of total billed charges,278.4,800.4,
CL TX POST HP ARTHRPLSTY DISLOC WO/AN LT,1000303,CDM,450,RC,27265,HCPCS,Outpatient,,,883,750.55,,717,81.2,,,percent of total billed charges,81.2% of total billed charges,288.21,32.64,,,percent of total billed charges,32.64% of total billed charges,653.42,74,,,percent of total billed charges,74% of total billed charges,653.42,74,,,percent of total billed charges,74% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,591.61,67,,,percent of total billed charges,67% of total billed charges,591.61,67,,,percent of total billed charges,67% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,671.08,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,291.04,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,794.7,90,,,percent of total billed charges,90% of total billed charges,794.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,782.34,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,706.4,80,,,percent of total billed charges,80% of total billed charges,706.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,803.53,91,,,percent of total billed charges,91% of total billed charges,288.21,32.64,,,percent of total billed charges,32.64% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,296.69,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,812.36,92,,,percent of total billed charges,92% of total billed charges,181.79,812.36,
CL TX POST HP ARTHRPLSTY DISLOC WO/AN RT,1000302,CDM,450,RC,27265,HCPCS,Outpatient,,,883,750.55,,717,81.2,,,percent of total billed charges,81.2% of total billed charges,288.21,32.64,,,percent of total billed charges,32.64% of total billed charges,653.42,74,,,percent of total billed charges,74% of total billed charges,653.42,74,,,percent of total billed charges,74% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,591.61,67,,,percent of total billed charges,67% of total billed charges,591.61,67,,,percent of total billed charges,67% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,671.08,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,291.04,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,794.7,90,,,percent of total billed charges,90% of total billed charges,794.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,782.34,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,706.4,80,,,percent of total billed charges,80% of total billed charges,706.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,803.53,91,,,percent of total billed charges,91% of total billed charges,288.21,32.64,,,percent of total billed charges,32.64% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,296.69,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,812.36,92,,,percent of total billed charges,92% of total billed charges,181.79,812.36,
CL TX POST HP ARTHRPLSTY DISLOC W/ANT LT,1000305,CDM,450,RC,27266,HCPCS,Outpatient,,,1311,1114.35,,1064.53,81.2,,,percent of total billed charges,81.2% of total billed charges,427.91,32.64,,,percent of total billed charges,32.64% of total billed charges,970.14,74,,,percent of total billed charges,74% of total billed charges,970.14,74,,,percent of total billed charges,74% of total billed charges,419.52,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,419.52,32,,,percent of total billed charges,32% of total billed charges,930.81,71,,,percent of total billed charges,71% of total billed charges,930.81,71,,,percent of total billed charges,71% of total billed charges,878.37,67,,,percent of total billed charges,67% of total billed charges,878.37,67,,,percent of total billed charges,67% of total billed charges,930.81,71,,,percent of total billed charges,71% of total billed charges,996.36,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,432.11,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,1179.9,90,,,percent of total billed charges,90% of total billed charges,1179.9,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,1161.55,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,419.52,32,,,percent of total billed charges,32% of total billed charges,1048.8,80,,,percent of total billed charges,80% of total billed charges,1048.8,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,1193.01,91,,,percent of total billed charges,91% of total billed charges,427.91,32.64,,,percent of total billed charges,32.64% of total billed charges,419.52,32,,,percent of total billed charges,32% of total billed charges,440.5,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,419.52,32,,,percent of total billed charges,32% of total billed charges,419.52,32,,,percent of total billed charges,32% of total billed charges,1206.12,92,,,percent of total billed charges,92% of total billed charges,419.52,1206.12,
CL TX POST HP ARTHRPLSTY DISLOC W/ANT RT,1000304,CDM,450,RC,27266,HCPCS,Outpatient,,,1311,1114.35,,1064.53,81.2,,,percent of total billed charges,81.2% of total billed charges,427.91,32.64,,,percent of total billed charges,32.64% of total billed charges,970.14,74,,,percent of total billed charges,74% of total billed charges,970.14,74,,,percent of total billed charges,74% of total billed charges,419.52,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,419.52,32,,,percent of total billed charges,32% of total billed charges,930.81,71,,,percent of total billed charges,71% of total billed charges,930.81,71,,,percent of total billed charges,71% of total billed charges,878.37,67,,,percent of total billed charges,67% of total billed charges,878.37,67,,,percent of total billed charges,67% of total billed charges,930.81,71,,,percent of total billed charges,71% of total billed charges,996.36,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,432.11,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,1179.9,90,,,percent of total billed charges,90% of total billed charges,1179.9,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,1161.55,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,419.52,32,,,percent of total billed charges,32% of total billed charges,1048.8,80,,,percent of total billed charges,80% of total billed charges,1048.8,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,1193.01,91,,,percent of total billed charges,91% of total billed charges,427.91,32.64,,,percent of total billed charges,32.64% of total billed charges,419.52,32,,,percent of total billed charges,32% of total billed charges,440.5,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,419.52,32,,,percent of total billed charges,32% of total billed charges,419.52,32,,,percent of total billed charges,32% of total billed charges,1206.12,92,,,percent of total billed charges,92% of total billed charges,419.52,1206.12,
CL TX FMRL FX PROXIMAL END HEAD WO MANIP,1000137,CDM,450,RC,27267,HCPCS,Outpatient,,,906,770.1,,735.67,81.2,,,percent of total billed charges,81.2% of total billed charges,295.72,32.64,,,percent of total billed charges,32.64% of total billed charges,670.44,74,,,percent of total billed charges,74% of total billed charges,670.44,74,,,percent of total billed charges,74% of total billed charges,289.92,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,289.92,32,,,percent of total billed charges,32% of total billed charges,643.26,71,,,percent of total billed charges,71% of total billed charges,643.26,71,,,percent of total billed charges,71% of total billed charges,607.02,67,,,percent of total billed charges,67% of total billed charges,607.02,67,,,percent of total billed charges,67% of total billed charges,643.26,71,,,percent of total billed charges,71% of total billed charges,688.56,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,298.62,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,802.72,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,289.92,32,,,percent of total billed charges,32% of total billed charges,724.8,80,,,percent of total billed charges,80% of total billed charges,724.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,824.46,91,,,percent of total billed charges,91% of total billed charges,295.72,32.64,,,percent of total billed charges,32.64% of total billed charges,289.92,32,,,percent of total billed charges,32% of total billed charges,304.42,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,289.92,32,,,percent of total billed charges,32% of total billed charges,289.92,32,,,percent of total billed charges,32% of total billed charges,833.52,92,,,percent of total billed charges,92% of total billed charges,181.79,833.52,
RMVL FB DEEP THIGH/KNEE,1000438,CDM,450,RC,27372,HCPCS,Outpatient,,,8083,6870.55,,6563.4,81.2,,,percent of total billed charges,81.2% of total billed charges,2638.29,32.64,,,percent of total billed charges,32.64% of total billed charges,5981.42,74,,,percent of total billed charges,74% of total billed charges,5981.42,74,,,percent of total billed charges,74% of total billed charges,2586.56,32,,,percent of total billed charges,32% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,2586.56,32,,,percent of total billed charges,32% of total billed charges,5738.93,71,,,percent of total billed charges,71% of total billed charges,5738.93,71,,,percent of total billed charges,71% of total billed charges,5415.61,67,,,percent of total billed charges,67% of total billed charges,5415.61,67,,,percent of total billed charges,67% of total billed charges,5738.93,71,,,percent of total billed charges,71% of total billed charges,6143.08,76,,,percent of total billed charges,76% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,2664.16,32.96,,,percent of total billed charges,32.96% of total billed charges,874.03,105,,,Fee Schedule,pays based on EAPG rates,7274.7,90,,,percent of total billed charges,90% of total billed charges,7274.7,90,,,percent of total billed charges,90% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,7161.54,88.6,,,percent of total billed charges,88.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,2586.56,32,,,percent of total billed charges,32% of total billed charges,6466.4,80,,,percent of total billed charges,80% of total billed charges,6466.4,80,,,percent of total billed charges,80% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,7355.53,91,,,percent of total billed charges,91% of total billed charges,2638.29,32.64,,,percent of total billed charges,32.64% of total billed charges,2586.56,32,,,percent of total billed charges,32% of total billed charges,2715.89,33.6,,,percent of total billed charges,33.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,2586.56,32,,,percent of total billed charges,32% of total billed charges,2586.56,32,,,percent of total billed charges,32% of total billed charges,7436.36,92,,,percent of total billed charges,92% of total billed charges,832.41,7436.36,
CL TX FEMORAL SHAFT FX WO MANIPULATION,1000138,CDM,450,RC,27500,HCPCS,Outpatient,,,1047,889.95,,850.16,81.2,,,percent of total billed charges,81.2% of total billed charges,341.74,32.64,,,percent of total billed charges,32.64% of total billed charges,774.78,74,,,percent of total billed charges,74% of total billed charges,774.78,74,,,percent of total billed charges,74% of total billed charges,335.04,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,335.04,32,,,percent of total billed charges,32% of total billed charges,743.37,71,,,percent of total billed charges,71% of total billed charges,743.37,71,,,percent of total billed charges,71% of total billed charges,701.49,67,,,percent of total billed charges,67% of total billed charges,701.49,67,,,percent of total billed charges,67% of total billed charges,743.37,71,,,percent of total billed charges,71% of total billed charges,795.72,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,345.09,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,942.3,90,,,percent of total billed charges,90% of total billed charges,942.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,927.64,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,335.04,32,,,percent of total billed charges,32% of total billed charges,837.6,80,,,percent of total billed charges,80% of total billed charges,837.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,952.77,91,,,percent of total billed charges,91% of total billed charges,341.74,32.64,,,percent of total billed charges,32.64% of total billed charges,335.04,32,,,percent of total billed charges,32% of total billed charges,351.79,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,335.04,32,,,percent of total billed charges,32% of total billed charges,335.04,32,,,percent of total billed charges,32% of total billed charges,963.24,92,,,percent of total billed charges,92% of total billed charges,181.79,963.24,
CL TX FMRL SFT FX WMANP W WO SK/SKTL TRC,1000139,CDM,450,RC,27502,HCPCS,Outpatient,,,1890,1606.5,,1534.68,81.2,,,percent of total billed charges,81.2% of total billed charges,616.9,32.64,,,percent of total billed charges,32.64% of total billed charges,1398.6,74,,,percent of total billed charges,74% of total billed charges,1398.6,74,,,percent of total billed charges,74% of total billed charges,604.8,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,604.8,32,,,percent of total billed charges,32% of total billed charges,1341.9,71,,,percent of total billed charges,71% of total billed charges,1341.9,71,,,percent of total billed charges,71% of total billed charges,1266.3,67,,,percent of total billed charges,67% of total billed charges,1266.3,67,,,percent of total billed charges,67% of total billed charges,1341.9,71,,,percent of total billed charges,71% of total billed charges,1436.4,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,622.94,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1701,90,,,percent of total billed charges,90% of total billed charges,1701,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1674.54,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,604.8,32,,,percent of total billed charges,32% of total billed charges,1512,80,,,percent of total billed charges,80% of total billed charges,1512,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1719.9,91,,,percent of total billed charges,91% of total billed charges,616.9,32.64,,,percent of total billed charges,32.64% of total billed charges,604.8,32,,,percent of total billed charges,32% of total billed charges,635.04,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,604.8,32,,,percent of total billed charges,32% of total billed charges,604.8,32,,,percent of total billed charges,32% of total billed charges,1738.8,92,,,percent of total billed charges,92% of total billed charges,181.79,1738.8,
CL TX FMRL FX DSTL END MDL/LAT CNDLE WOM,1000140,CDM,450,RC,27508,HCPCS,Outpatient,,,1022,868.7,,829.86,81.2,,,percent of total billed charges,81.2% of total billed charges,333.58,32.64,,,percent of total billed charges,32.64% of total billed charges,756.28,74,,,percent of total billed charges,74% of total billed charges,756.28,74,,,percent of total billed charges,74% of total billed charges,327.04,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,327.04,32,,,percent of total billed charges,32% of total billed charges,725.62,71,,,percent of total billed charges,71% of total billed charges,725.62,71,,,percent of total billed charges,71% of total billed charges,684.74,67,,,percent of total billed charges,67% of total billed charges,684.74,67,,,percent of total billed charges,67% of total billed charges,725.62,71,,,percent of total billed charges,71% of total billed charges,776.72,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,336.85,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,919.8,90,,,percent of total billed charges,90% of total billed charges,919.8,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,905.49,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,327.04,32,,,percent of total billed charges,32% of total billed charges,817.6,80,,,percent of total billed charges,80% of total billed charges,817.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,930.02,91,,,percent of total billed charges,91% of total billed charges,333.58,32.64,,,percent of total billed charges,32.64% of total billed charges,327.04,32,,,percent of total billed charges,32% of total billed charges,343.39,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,327.04,32,,,percent of total billed charges,32% of total billed charges,327.04,32,,,percent of total billed charges,32% of total billed charges,940.24,92,,,percent of total billed charges,92% of total billed charges,181.79,940.24,
CL TX FMRL FX DSTL END MED/LAT CNDL WMAN,1000141,CDM,450,RC,27510,HCPCS,Outpatient,,,1630,1385.5,,1323.56,81.2,,,percent of total billed charges,81.2% of total billed charges,532.03,32.64,,,percent of total billed charges,32.64% of total billed charges,1206.2,74,,,percent of total billed charges,74% of total billed charges,1206.2,74,,,percent of total billed charges,74% of total billed charges,521.6,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,521.6,32,,,percent of total billed charges,32% of total billed charges,1157.3,71,,,percent of total billed charges,71% of total billed charges,1157.3,71,,,percent of total billed charges,71% of total billed charges,1092.1,67,,,percent of total billed charges,67% of total billed charges,1092.1,67,,,percent of total billed charges,67% of total billed charges,1157.3,71,,,percent of total billed charges,71% of total billed charges,1238.8,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,537.25,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1467,90,,,percent of total billed charges,90% of total billed charges,1467,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1444.18,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,521.6,32,,,percent of total billed charges,32% of total billed charges,1304,80,,,percent of total billed charges,80% of total billed charges,1304,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1483.3,91,,,percent of total billed charges,91% of total billed charges,532.03,32.64,,,percent of total billed charges,32.64% of total billed charges,521.6,32,,,percent of total billed charges,32% of total billed charges,547.68,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,521.6,32,,,percent of total billed charges,32% of total billed charges,521.6,32,,,percent of total billed charges,32% of total billed charges,1499.6,92,,,percent of total billed charges,92% of total billed charges,181.79,1499.6,
CL TX PATELLAR FX WO MANIPULATION,1000142,CDM,450,RC,27520,HCPCS,Outpatient,,,492,418.2,,399.5,81.2,,,percent of total billed charges,81.2% of total billed charges,160.59,32.64,,,percent of total billed charges,32.64% of total billed charges,364.08,74,,,percent of total billed charges,74% of total billed charges,364.08,74,,,percent of total billed charges,74% of total billed charges,157.44,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,157.44,32,,,percent of total billed charges,32% of total billed charges,349.32,71,,,percent of total billed charges,71% of total billed charges,349.32,71,,,percent of total billed charges,71% of total billed charges,329.64,67,,,percent of total billed charges,67% of total billed charges,329.64,67,,,percent of total billed charges,67% of total billed charges,349.32,71,,,percent of total billed charges,71% of total billed charges,373.92,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,162.16,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,442.8,90,,,percent of total billed charges,90% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,435.91,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,157.44,32,,,percent of total billed charges,32% of total billed charges,393.6,80,,,percent of total billed charges,80% of total billed charges,393.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,447.72,91,,,percent of total billed charges,91% of total billed charges,160.59,32.64,,,percent of total billed charges,32.64% of total billed charges,157.44,32,,,percent of total billed charges,32% of total billed charges,165.31,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,157.44,32,,,percent of total billed charges,32% of total billed charges,157.44,32,,,percent of total billed charges,32% of total billed charges,452.64,92,,,percent of total billed charges,92% of total billed charges,157.44,452.64,
CL TX TIBIAL FX PROXIMAL PLATEAU WO MANI,1000143,CDM,450,RC,27530,HCPCS,Outpatient,,,668,567.8,,542.42,81.2,,,percent of total billed charges,81.2% of total billed charges,218.04,32.64,,,percent of total billed charges,32.64% of total billed charges,494.32,74,,,percent of total billed charges,74% of total billed charges,494.32,74,,,percent of total billed charges,74% of total billed charges,213.76,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,213.76,32,,,percent of total billed charges,32% of total billed charges,474.28,71,,,percent of total billed charges,71% of total billed charges,474.28,71,,,percent of total billed charges,71% of total billed charges,447.56,67,,,percent of total billed charges,67% of total billed charges,447.56,67,,,percent of total billed charges,67% of total billed charges,474.28,71,,,percent of total billed charges,71% of total billed charges,507.68,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,220.17,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,601.2,90,,,percent of total billed charges,90% of total billed charges,601.2,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,591.85,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,213.76,32,,,percent of total billed charges,32% of total billed charges,534.4,80,,,percent of total billed charges,80% of total billed charges,534.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,607.88,91,,,percent of total billed charges,91% of total billed charges,218.04,32.64,,,percent of total billed charges,32.64% of total billed charges,213.76,32,,,percent of total billed charges,32% of total billed charges,224.45,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,213.76,32,,,percent of total billed charges,32% of total billed charges,213.76,32,,,percent of total billed charges,32% of total billed charges,614.56,92,,,percent of total billed charges,92% of total billed charges,181.79,614.56,
CL TX KNEE DISLOCATION WO ANESTHESIA LT,1000307,CDM,450,RC,27550,HCPCS,Outpatient,,,982,834.7,,797.38,81.2,,,percent of total billed charges,81.2% of total billed charges,320.52,32.64,,,percent of total billed charges,32.64% of total billed charges,726.68,74,,,percent of total billed charges,74% of total billed charges,726.68,74,,,percent of total billed charges,74% of total billed charges,314.24,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,314.24,32,,,percent of total billed charges,32% of total billed charges,697.22,71,,,percent of total billed charges,71% of total billed charges,697.22,71,,,percent of total billed charges,71% of total billed charges,657.94,67,,,percent of total billed charges,67% of total billed charges,657.94,67,,,percent of total billed charges,67% of total billed charges,697.22,71,,,percent of total billed charges,71% of total billed charges,746.32,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,323.67,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,883.8,90,,,percent of total billed charges,90% of total billed charges,883.8,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,870.05,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,314.24,32,,,percent of total billed charges,32% of total billed charges,785.6,80,,,percent of total billed charges,80% of total billed charges,785.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,893.62,91,,,percent of total billed charges,91% of total billed charges,320.52,32.64,,,percent of total billed charges,32.64% of total billed charges,314.24,32,,,percent of total billed charges,32% of total billed charges,329.95,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,314.24,32,,,percent of total billed charges,32% of total billed charges,314.24,32,,,percent of total billed charges,32% of total billed charges,903.44,92,,,percent of total billed charges,92% of total billed charges,181.79,903.44,
CL TX KNEE DISLOCATION WO ANESTHESIA RT,1000306,CDM,450,RC,27550,HCPCS,Outpatient,,,982,834.7,,797.38,81.2,,,percent of total billed charges,81.2% of total billed charges,320.52,32.64,,,percent of total billed charges,32.64% of total billed charges,726.68,74,,,percent of total billed charges,74% of total billed charges,726.68,74,,,percent of total billed charges,74% of total billed charges,314.24,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,314.24,32,,,percent of total billed charges,32% of total billed charges,697.22,71,,,percent of total billed charges,71% of total billed charges,697.22,71,,,percent of total billed charges,71% of total billed charges,657.94,67,,,percent of total billed charges,67% of total billed charges,657.94,67,,,percent of total billed charges,67% of total billed charges,697.22,71,,,percent of total billed charges,71% of total billed charges,746.32,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,323.67,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,883.8,90,,,percent of total billed charges,90% of total billed charges,883.8,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,870.05,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,314.24,32,,,percent of total billed charges,32% of total billed charges,785.6,80,,,percent of total billed charges,80% of total billed charges,785.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,893.62,91,,,percent of total billed charges,91% of total billed charges,320.52,32.64,,,percent of total billed charges,32.64% of total billed charges,314.24,32,,,percent of total billed charges,32% of total billed charges,329.95,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,314.24,32,,,percent of total billed charges,32% of total billed charges,314.24,32,,,percent of total billed charges,32% of total billed charges,903.44,92,,,percent of total billed charges,92% of total billed charges,181.79,903.44,
CL TX PATELLAR DISLOCAT WO ANESTHESIA LT,1000309,CDM,450,RC,27560,HCPCS,Outpatient,,,655,556.75,,531.86,81.2,,,percent of total billed charges,81.2% of total billed charges,213.79,32.64,,,percent of total billed charges,32.64% of total billed charges,484.7,74,,,percent of total billed charges,74% of total billed charges,484.7,74,,,percent of total billed charges,74% of total billed charges,209.6,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,209.6,32,,,percent of total billed charges,32% of total billed charges,465.05,71,,,percent of total billed charges,71% of total billed charges,465.05,71,,,percent of total billed charges,71% of total billed charges,438.85,67,,,percent of total billed charges,67% of total billed charges,438.85,67,,,percent of total billed charges,67% of total billed charges,465.05,71,,,percent of total billed charges,71% of total billed charges,497.8,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,215.89,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,589.5,90,,,percent of total billed charges,90% of total billed charges,589.5,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,580.33,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,209.6,32,,,percent of total billed charges,32% of total billed charges,524,80,,,percent of total billed charges,80% of total billed charges,524,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,596.05,91,,,percent of total billed charges,91% of total billed charges,213.79,32.64,,,percent of total billed charges,32.64% of total billed charges,209.6,32,,,percent of total billed charges,32% of total billed charges,220.08,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,209.6,32,,,percent of total billed charges,32% of total billed charges,209.6,32,,,percent of total billed charges,32% of total billed charges,602.6,92,,,percent of total billed charges,92% of total billed charges,181.79,602.6,
CL TX PATELLAR DISLOCAT WO ANESTHESIA RT,1000308,CDM,450,RC,27560,HCPCS,Outpatient,,,655,556.75,,531.86,81.2,,,percent of total billed charges,81.2% of total billed charges,213.79,32.64,,,percent of total billed charges,32.64% of total billed charges,484.7,74,,,percent of total billed charges,74% of total billed charges,484.7,74,,,percent of total billed charges,74% of total billed charges,209.6,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,209.6,32,,,percent of total billed charges,32% of total billed charges,465.05,71,,,percent of total billed charges,71% of total billed charges,465.05,71,,,percent of total billed charges,71% of total billed charges,438.85,67,,,percent of total billed charges,67% of total billed charges,438.85,67,,,percent of total billed charges,67% of total billed charges,465.05,71,,,percent of total billed charges,71% of total billed charges,497.8,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,215.89,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,589.5,90,,,percent of total billed charges,90% of total billed charges,589.5,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,580.33,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,209.6,32,,,percent of total billed charges,32% of total billed charges,524,80,,,percent of total billed charges,80% of total billed charges,524,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,596.05,91,,,percent of total billed charges,91% of total billed charges,213.79,32.64,,,percent of total billed charges,32.64% of total billed charges,209.6,32,,,percent of total billed charges,32% of total billed charges,220.08,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,209.6,32,,,percent of total billed charges,32% of total billed charges,209.6,32,,,percent of total billed charges,32% of total billed charges,602.6,92,,,percent of total billed charges,92% of total billed charges,181.79,602.6,
CL TX PATELLAR DISLOCAT W ANESTHESIA LT,1000311,CDM,450,RC,27562,HCPCS,Outpatient,,,883,750.55,,717,81.2,,,percent of total billed charges,81.2% of total billed charges,288.21,32.64,,,percent of total billed charges,32.64% of total billed charges,653.42,74,,,percent of total billed charges,74% of total billed charges,653.42,74,,,percent of total billed charges,74% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,591.61,67,,,percent of total billed charges,67% of total billed charges,591.61,67,,,percent of total billed charges,67% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,671.08,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,291.04,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,794.7,90,,,percent of total billed charges,90% of total billed charges,794.7,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,782.34,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,706.4,80,,,percent of total billed charges,80% of total billed charges,706.4,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,803.53,91,,,percent of total billed charges,91% of total billed charges,288.21,32.64,,,percent of total billed charges,32.64% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,296.69,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,812.36,92,,,percent of total billed charges,92% of total billed charges,282.56,812.36,
CL TX PATELLAR DISLOCAT W ANESTHESIA RT,1000310,CDM,450,RC,27562,HCPCS,Outpatient,,,883,750.55,,717,81.2,,,percent of total billed charges,81.2% of total billed charges,288.21,32.64,,,percent of total billed charges,32.64% of total billed charges,653.42,74,,,percent of total billed charges,74% of total billed charges,653.42,74,,,percent of total billed charges,74% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,591.61,67,,,percent of total billed charges,67% of total billed charges,591.61,67,,,percent of total billed charges,67% of total billed charges,626.93,71,,,percent of total billed charges,71% of total billed charges,671.08,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,291.04,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,794.7,90,,,percent of total billed charges,90% of total billed charges,794.7,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,782.34,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,706.4,80,,,percent of total billed charges,80% of total billed charges,706.4,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,803.53,91,,,percent of total billed charges,91% of total billed charges,288.21,32.64,,,percent of total billed charges,32.64% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,296.69,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,282.56,32,,,percent of total billed charges,32% of total billed charges,282.56,32,,,percent of total billed charges,32% of total billed charges,812.36,92,,,percent of total billed charges,92% of total billed charges,282.56,812.36,
CL TX TIBIAL SHAFT FX W MANIPULATION,1000146,CDM,450,RC,27750,HCPCS,Outpatient,,,548,465.8,,444.98,81.2,,,percent of total billed charges,81.2% of total billed charges,178.87,32.64,,,percent of total billed charges,32.64% of total billed charges,405.52,74,,,percent of total billed charges,74% of total billed charges,405.52,74,,,percent of total billed charges,74% of total billed charges,175.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,175.36,32,,,percent of total billed charges,32% of total billed charges,389.08,71,,,percent of total billed charges,71% of total billed charges,389.08,71,,,percent of total billed charges,71% of total billed charges,367.16,67,,,percent of total billed charges,67% of total billed charges,367.16,67,,,percent of total billed charges,67% of total billed charges,389.08,71,,,percent of total billed charges,71% of total billed charges,416.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,180.62,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,493.2,90,,,percent of total billed charges,90% of total billed charges,493.2,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,485.53,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,175.36,32,,,percent of total billed charges,32% of total billed charges,438.4,80,,,percent of total billed charges,80% of total billed charges,438.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,498.68,91,,,percent of total billed charges,91% of total billed charges,178.87,32.64,,,percent of total billed charges,32.64% of total billed charges,175.36,32,,,percent of total billed charges,32% of total billed charges,184.13,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,175.36,32,,,percent of total billed charges,32% of total billed charges,175.36,32,,,percent of total billed charges,32% of total billed charges,504.16,92,,,percent of total billed charges,92% of total billed charges,175.36,504.16,
CL TX W/MANIPULAT OF TIBIAL SHAFT W/F LT,1000313,CDM,450,RC,27752,HCPCS,Outpatient,,,885,752.25,,718.62,81.2,,,percent of total billed charges,81.2% of total billed charges,288.86,32.64,,,percent of total billed charges,32.64% of total billed charges,654.9,74,,,percent of total billed charges,74% of total billed charges,654.9,74,,,percent of total billed charges,74% of total billed charges,283.2,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,283.2,32,,,percent of total billed charges,32% of total billed charges,628.35,71,,,percent of total billed charges,71% of total billed charges,628.35,71,,,percent of total billed charges,71% of total billed charges,592.95,67,,,percent of total billed charges,67% of total billed charges,592.95,67,,,percent of total billed charges,67% of total billed charges,628.35,71,,,percent of total billed charges,71% of total billed charges,672.6,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,291.7,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,796.5,90,,,percent of total billed charges,90% of total billed charges,796.5,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,784.11,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,283.2,32,,,percent of total billed charges,32% of total billed charges,708,80,,,percent of total billed charges,80% of total billed charges,708,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,805.35,91,,,percent of total billed charges,91% of total billed charges,288.86,32.64,,,percent of total billed charges,32.64% of total billed charges,283.2,32,,,percent of total billed charges,32% of total billed charges,297.36,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,283.2,32,,,percent of total billed charges,32% of total billed charges,283.2,32,,,percent of total billed charges,32% of total billed charges,814.2,92,,,percent of total billed charges,92% of total billed charges,181.79,814.2,
CL TX W/MANIPULAT OF TIBIAL SHAFT W/F RT,1000312,CDM,450,RC,27752,HCPCS,Outpatient,,,885,752.25,,718.62,81.2,,,percent of total billed charges,81.2% of total billed charges,288.86,32.64,,,percent of total billed charges,32.64% of total billed charges,654.9,74,,,percent of total billed charges,74% of total billed charges,654.9,74,,,percent of total billed charges,74% of total billed charges,283.2,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,283.2,32,,,percent of total billed charges,32% of total billed charges,628.35,71,,,percent of total billed charges,71% of total billed charges,628.35,71,,,percent of total billed charges,71% of total billed charges,592.95,67,,,percent of total billed charges,67% of total billed charges,592.95,67,,,percent of total billed charges,67% of total billed charges,628.35,71,,,percent of total billed charges,71% of total billed charges,672.6,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,291.7,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,796.5,90,,,percent of total billed charges,90% of total billed charges,796.5,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,784.11,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,283.2,32,,,percent of total billed charges,32% of total billed charges,708,80,,,percent of total billed charges,80% of total billed charges,708,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,805.35,91,,,percent of total billed charges,91% of total billed charges,288.86,32.64,,,percent of total billed charges,32.64% of total billed charges,283.2,32,,,percent of total billed charges,32% of total billed charges,297.36,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,283.2,32,,,percent of total billed charges,32% of total billed charges,283.2,32,,,percent of total billed charges,32% of total billed charges,814.2,92,,,percent of total billed charges,92% of total billed charges,181.79,814.2,
CL TX MEDIAL MALLEOLUS FX WO MANIP,1000147,CDM,450,RC,27760,HCPCS,Outpatient,,,519,441.15,,421.43,81.2,,,percent of total billed charges,81.2% of total billed charges,169.4,32.64,,,percent of total billed charges,32.64% of total billed charges,384.06,74,,,percent of total billed charges,74% of total billed charges,384.06,74,,,percent of total billed charges,74% of total billed charges,166.08,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,166.08,32,,,percent of total billed charges,32% of total billed charges,368.49,71,,,percent of total billed charges,71% of total billed charges,368.49,71,,,percent of total billed charges,71% of total billed charges,347.73,67,,,percent of total billed charges,67% of total billed charges,347.73,67,,,percent of total billed charges,67% of total billed charges,368.49,71,,,percent of total billed charges,71% of total billed charges,394.44,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,171.06,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,467.1,90,,,percent of total billed charges,90% of total billed charges,467.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,459.83,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,166.08,32,,,percent of total billed charges,32% of total billed charges,415.2,80,,,percent of total billed charges,80% of total billed charges,415.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,472.29,91,,,percent of total billed charges,91% of total billed charges,169.4,32.64,,,percent of total billed charges,32.64% of total billed charges,166.08,32,,,percent of total billed charges,32% of total billed charges,174.38,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,166.08,32,,,percent of total billed charges,32% of total billed charges,166.08,32,,,percent of total billed charges,32% of total billed charges,477.48,92,,,percent of total billed charges,92% of total billed charges,166.08,477.48,
CL TX OF MEDIAL MALLEOLUS FX W/MAN W/WO,1000207,CDM,450,RC,27762,HCPCS,Outpatient,,,921,782.85,,747.85,81.2,,,percent of total billed charges,81.2% of total billed charges,300.61,32.64,,,percent of total billed charges,32.64% of total billed charges,681.54,74,,,percent of total billed charges,74% of total billed charges,681.54,74,,,percent of total billed charges,74% of total billed charges,294.72,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,294.72,32,,,percent of total billed charges,32% of total billed charges,653.91,71,,,percent of total billed charges,71% of total billed charges,653.91,71,,,percent of total billed charges,71% of total billed charges,617.07,67,,,percent of total billed charges,67% of total billed charges,617.07,67,,,percent of total billed charges,67% of total billed charges,653.91,71,,,percent of total billed charges,71% of total billed charges,699.96,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,303.56,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,828.9,90,,,percent of total billed charges,90% of total billed charges,828.9,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,816.01,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,294.72,32,,,percent of total billed charges,32% of total billed charges,736.8,80,,,percent of total billed charges,80% of total billed charges,736.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,838.11,91,,,percent of total billed charges,91% of total billed charges,300.61,32.64,,,percent of total billed charges,32.64% of total billed charges,294.72,32,,,percent of total billed charges,32% of total billed charges,309.46,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,294.72,32,,,percent of total billed charges,32% of total billed charges,294.72,32,,,percent of total billed charges,32% of total billed charges,847.32,92,,,percent of total billed charges,92% of total billed charges,181.79,847.32,
CL TX POSTERIOR MALLEOLUS FX WO MANIP,1000148,CDM,450,RC,27767,HCPCS,Outpatient,,,423,359.55,,343.48,81.2,,,percent of total billed charges,81.2% of total billed charges,138.07,32.64,,,percent of total billed charges,32.64% of total billed charges,313.02,74,,,percent of total billed charges,74% of total billed charges,313.02,74,,,percent of total billed charges,74% of total billed charges,135.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,135.36,32,,,percent of total billed charges,32% of total billed charges,300.33,71,,,percent of total billed charges,71% of total billed charges,300.33,71,,,percent of total billed charges,71% of total billed charges,283.41,67,,,percent of total billed charges,67% of total billed charges,283.41,67,,,percent of total billed charges,67% of total billed charges,300.33,71,,,percent of total billed charges,71% of total billed charges,321.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,139.42,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,380.7,90,,,percent of total billed charges,90% of total billed charges,380.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,374.78,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,135.36,32,,,percent of total billed charges,32% of total billed charges,338.4,80,,,percent of total billed charges,80% of total billed charges,338.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,384.93,91,,,percent of total billed charges,91% of total billed charges,138.07,32.64,,,percent of total billed charges,32.64% of total billed charges,135.36,32,,,percent of total billed charges,32% of total billed charges,142.13,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,135.36,32,,,percent of total billed charges,32% of total billed charges,135.36,32,,,percent of total billed charges,32% of total billed charges,389.16,92,,,percent of total billed charges,92% of total billed charges,135.36,389.16,
CL TX POSTERIOR MALLEOLUS FX W MANIPLTN,1000149,CDM,450,RC,27768,HCPCS,Outpatient,,,843,716.55,,684.52,81.2,,,percent of total billed charges,81.2% of total billed charges,275.16,32.64,,,percent of total billed charges,32.64% of total billed charges,623.82,74,,,percent of total billed charges,74% of total billed charges,623.82,74,,,percent of total billed charges,74% of total billed charges,269.76,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,269.76,32,,,percent of total billed charges,32% of total billed charges,598.53,71,,,percent of total billed charges,71% of total billed charges,598.53,71,,,percent of total billed charges,71% of total billed charges,564.81,67,,,percent of total billed charges,67% of total billed charges,564.81,67,,,percent of total billed charges,67% of total billed charges,598.53,71,,,percent of total billed charges,71% of total billed charges,640.68,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,277.85,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,758.7,90,,,percent of total billed charges,90% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,746.9,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,269.76,32,,,percent of total billed charges,32% of total billed charges,674.4,80,,,percent of total billed charges,80% of total billed charges,674.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,767.13,91,,,percent of total billed charges,91% of total billed charges,275.16,32.64,,,percent of total billed charges,32.64% of total billed charges,269.76,32,,,percent of total billed charges,32% of total billed charges,283.25,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,269.76,32,,,percent of total billed charges,32% of total billed charges,269.76,32,,,percent of total billed charges,32% of total billed charges,775.56,92,,,percent of total billed charges,92% of total billed charges,181.79,775.56,
CL TX PROXIMAL FIBULA.SHFT FX WO MANIP,1000150,CDM,450,RC,27780,HCPCS,Outpatient,,,459,390.15,,372.71,81.2,,,percent of total billed charges,81.2% of total billed charges,149.82,32.64,,,percent of total billed charges,32.64% of total billed charges,339.66,74,,,percent of total billed charges,74% of total billed charges,339.66,74,,,percent of total billed charges,74% of total billed charges,146.88,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,146.88,32,,,percent of total billed charges,32% of total billed charges,325.89,71,,,percent of total billed charges,71% of total billed charges,325.89,71,,,percent of total billed charges,71% of total billed charges,307.53,67,,,percent of total billed charges,67% of total billed charges,307.53,67,,,percent of total billed charges,67% of total billed charges,325.89,71,,,percent of total billed charges,71% of total billed charges,348.84,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,151.29,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,413.1,90,,,percent of total billed charges,90% of total billed charges,413.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,406.67,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,146.88,32,,,percent of total billed charges,32% of total billed charges,367.2,80,,,percent of total billed charges,80% of total billed charges,367.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,417.69,91,,,percent of total billed charges,91% of total billed charges,149.82,32.64,,,percent of total billed charges,32.64% of total billed charges,146.88,32,,,percent of total billed charges,32% of total billed charges,154.22,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,146.88,32,,,percent of total billed charges,32% of total billed charges,146.88,32,,,percent of total billed charges,32% of total billed charges,422.28,92,,,percent of total billed charges,92% of total billed charges,146.88,422.28,
CL TX DISTAL FIBULAR FX WO MANIPULATION,1000151,CDM,450,RC,27786,HCPCS,Outpatient,,,490,416.5,,397.88,81.2,,,percent of total billed charges,81.2% of total billed charges,159.94,32.64,,,percent of total billed charges,32.64% of total billed charges,362.6,74,,,percent of total billed charges,74% of total billed charges,362.6,74,,,percent of total billed charges,74% of total billed charges,156.8,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,156.8,32,,,percent of total billed charges,32% of total billed charges,347.9,71,,,percent of total billed charges,71% of total billed charges,347.9,71,,,percent of total billed charges,71% of total billed charges,328.3,67,,,percent of total billed charges,67% of total billed charges,328.3,67,,,percent of total billed charges,67% of total billed charges,347.9,71,,,percent of total billed charges,71% of total billed charges,372.4,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,161.5,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,441,90,,,percent of total billed charges,90% of total billed charges,441,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,434.14,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,156.8,32,,,percent of total billed charges,32% of total billed charges,392,80,,,percent of total billed charges,80% of total billed charges,392,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,445.9,91,,,percent of total billed charges,91% of total billed charges,159.94,32.64,,,percent of total billed charges,32.64% of total billed charges,156.8,32,,,percent of total billed charges,32% of total billed charges,164.64,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,156.8,32,,,percent of total billed charges,32% of total billed charges,156.8,32,,,percent of total billed charges,32% of total billed charges,450.8,92,,,percent of total billed charges,92% of total billed charges,156.8,450.8,
CL TX DISTAL FIBULAR FX W MAN-LT,1000358,CDM,450,RC,27788,HCPCS,Outpatient,,,759,645.15,,616.31,81.2,,,percent of total billed charges,81.2% of total billed charges,247.74,32.64,,,percent of total billed charges,32.64% of total billed charges,561.66,74,,,percent of total billed charges,74% of total billed charges,561.66,74,,,percent of total billed charges,74% of total billed charges,242.88,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,242.88,32,,,percent of total billed charges,32% of total billed charges,538.89,71,,,percent of total billed charges,71% of total billed charges,538.89,71,,,percent of total billed charges,71% of total billed charges,508.53,67,,,percent of total billed charges,67% of total billed charges,508.53,67,,,percent of total billed charges,67% of total billed charges,538.89,71,,,percent of total billed charges,71% of total billed charges,576.84,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,250.17,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,683.1,90,,,percent of total billed charges,90% of total billed charges,683.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,672.47,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,242.88,32,,,percent of total billed charges,32% of total billed charges,607.2,80,,,percent of total billed charges,80% of total billed charges,607.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,690.69,91,,,percent of total billed charges,91% of total billed charges,247.74,32.64,,,percent of total billed charges,32.64% of total billed charges,242.88,32,,,percent of total billed charges,32% of total billed charges,255.02,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,242.88,32,,,percent of total billed charges,32% of total billed charges,242.88,32,,,percent of total billed charges,32% of total billed charges,698.28,92,,,percent of total billed charges,92% of total billed charges,181.79,698.28,
CL TX DISTAL FIBULAR FX W MAN-RT,1000152,CDM,450,RC,27788,HCPCS,Outpatient,,,759,645.15,,616.31,81.2,,,percent of total billed charges,81.2% of total billed charges,247.74,32.64,,,percent of total billed charges,32.64% of total billed charges,561.66,74,,,percent of total billed charges,74% of total billed charges,561.66,74,,,percent of total billed charges,74% of total billed charges,242.88,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,242.88,32,,,percent of total billed charges,32% of total billed charges,538.89,71,,,percent of total billed charges,71% of total billed charges,538.89,71,,,percent of total billed charges,71% of total billed charges,508.53,67,,,percent of total billed charges,67% of total billed charges,508.53,67,,,percent of total billed charges,67% of total billed charges,538.89,71,,,percent of total billed charges,71% of total billed charges,576.84,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,250.17,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,683.1,90,,,percent of total billed charges,90% of total billed charges,683.1,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,672.47,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,242.88,32,,,percent of total billed charges,32% of total billed charges,607.2,80,,,percent of total billed charges,80% of total billed charges,607.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,690.69,91,,,percent of total billed charges,91% of total billed charges,247.74,32.64,,,percent of total billed charges,32.64% of total billed charges,242.88,32,,,percent of total billed charges,32% of total billed charges,255.02,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,242.88,32,,,percent of total billed charges,32% of total billed charges,242.88,32,,,percent of total billed charges,32% of total billed charges,698.28,92,,,percent of total billed charges,92% of total billed charges,181.79,698.28,
CL TX BIMALLEOLAR ANK FX WO MANIPULATION,1000153,CDM,450,RC,27808,HCPCS,Outpatient,,,490,416.5,,397.88,81.2,,,percent of total billed charges,81.2% of total billed charges,159.94,32.64,,,percent of total billed charges,32.64% of total billed charges,362.6,74,,,percent of total billed charges,74% of total billed charges,362.6,74,,,percent of total billed charges,74% of total billed charges,156.8,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,156.8,32,,,percent of total billed charges,32% of total billed charges,347.9,71,,,percent of total billed charges,71% of total billed charges,347.9,71,,,percent of total billed charges,71% of total billed charges,328.3,67,,,percent of total billed charges,67% of total billed charges,328.3,67,,,percent of total billed charges,67% of total billed charges,347.9,71,,,percent of total billed charges,71% of total billed charges,372.4,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,161.5,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,441,90,,,percent of total billed charges,90% of total billed charges,441,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,434.14,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,156.8,32,,,percent of total billed charges,32% of total billed charges,392,80,,,percent of total billed charges,80% of total billed charges,392,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,445.9,91,,,percent of total billed charges,91% of total billed charges,159.94,32.64,,,percent of total billed charges,32.64% of total billed charges,156.8,32,,,percent of total billed charges,32% of total billed charges,164.64,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,156.8,32,,,percent of total billed charges,32% of total billed charges,156.8,32,,,percent of total billed charges,32% of total billed charges,450.8,92,,,percent of total billed charges,92% of total billed charges,156.8,450.8,
CL TX BIMALLEOLAR ANKLE FX W MANIPU LT,1000363,CDM,450,RC,27810,HCPCS,Outpatient,,,877,745.45,,712.12,81.2,,,percent of total billed charges,81.2% of total billed charges,286.25,32.64,,,percent of total billed charges,32.64% of total billed charges,648.98,74,,,percent of total billed charges,74% of total billed charges,648.98,74,,,percent of total billed charges,74% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,587.59,67,,,percent of total billed charges,67% of total billed charges,587.59,67,,,percent of total billed charges,67% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,666.52,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,289.06,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,789.3,90,,,percent of total billed charges,90% of total billed charges,789.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,777.02,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,701.6,80,,,percent of total billed charges,80% of total billed charges,701.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,798.07,91,,,percent of total billed charges,91% of total billed charges,286.25,32.64,,,percent of total billed charges,32.64% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,294.67,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,806.84,92,,,percent of total billed charges,92% of total billed charges,181.79,806.84,
CL TX BIMALLEOLAR ANKLE FX W MANIPU RT,1000154,CDM,450,RC,27810,HCPCS,Outpatient,,,877,745.45,,712.12,81.2,,,percent of total billed charges,81.2% of total billed charges,286.25,32.64,,,percent of total billed charges,32.64% of total billed charges,648.98,74,,,percent of total billed charges,74% of total billed charges,648.98,74,,,percent of total billed charges,74% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,587.59,67,,,percent of total billed charges,67% of total billed charges,587.59,67,,,percent of total billed charges,67% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,666.52,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,289.06,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,789.3,90,,,percent of total billed charges,90% of total billed charges,789.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,777.02,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,701.6,80,,,percent of total billed charges,80% of total billed charges,701.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,798.07,91,,,percent of total billed charges,91% of total billed charges,286.25,32.64,,,percent of total billed charges,32.64% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,294.67,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,806.84,92,,,percent of total billed charges,92% of total billed charges,181.79,806.84,
CL TX BIMALLEOLAR ANKLE FX W MANIPU BIL,1000364,CDM,450,RC,27810,HCPCS,Outpatient,,,1753,1490.05,,1423.44,81.2,,,percent of total billed charges,81.2% of total billed charges,572.18,32.64,,,percent of total billed charges,32.64% of total billed charges,1297.22,74,,,percent of total billed charges,74% of total billed charges,1297.22,74,,,percent of total billed charges,74% of total billed charges,560.96,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,560.96,32,,,percent of total billed charges,32% of total billed charges,1244.63,71,,,percent of total billed charges,71% of total billed charges,1244.63,71,,,percent of total billed charges,71% of total billed charges,1174.51,67,,,percent of total billed charges,67% of total billed charges,1174.51,67,,,percent of total billed charges,67% of total billed charges,1244.63,71,,,percent of total billed charges,71% of total billed charges,1332.28,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,577.79,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1577.7,90,,,percent of total billed charges,90% of total billed charges,1577.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1553.16,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,560.96,32,,,percent of total billed charges,32% of total billed charges,1402.4,80,,,percent of total billed charges,80% of total billed charges,1402.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1595.23,91,,,percent of total billed charges,91% of total billed charges,572.18,32.64,,,percent of total billed charges,32.64% of total billed charges,560.96,32,,,percent of total billed charges,32% of total billed charges,589.01,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,560.96,32,,,percent of total billed charges,32% of total billed charges,560.96,32,,,percent of total billed charges,32% of total billed charges,1612.76,92,,,percent of total billed charges,92% of total billed charges,181.79,1612.76,
CL TX TRIMALLEOLAR ANKLE FX WO MANIPULAT,1000155,CDM,450,RC,27816,HCPCS,Outpatient,,,498,423.3,,404.38,81.2,,,percent of total billed charges,81.2% of total billed charges,162.55,32.64,,,percent of total billed charges,32.64% of total billed charges,368.52,74,,,percent of total billed charges,74% of total billed charges,368.52,74,,,percent of total billed charges,74% of total billed charges,159.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,159.36,32,,,percent of total billed charges,32% of total billed charges,353.58,71,,,percent of total billed charges,71% of total billed charges,353.58,71,,,percent of total billed charges,71% of total billed charges,333.66,67,,,percent of total billed charges,67% of total billed charges,333.66,67,,,percent of total billed charges,67% of total billed charges,353.58,71,,,percent of total billed charges,71% of total billed charges,378.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,164.14,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,448.2,90,,,percent of total billed charges,90% of total billed charges,448.2,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,441.23,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,159.36,32,,,percent of total billed charges,32% of total billed charges,398.4,80,,,percent of total billed charges,80% of total billed charges,398.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,453.18,91,,,percent of total billed charges,91% of total billed charges,162.55,32.64,,,percent of total billed charges,32.64% of total billed charges,159.36,32,,,percent of total billed charges,32% of total billed charges,167.33,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,159.36,32,,,percent of total billed charges,32% of total billed charges,159.36,32,,,percent of total billed charges,32% of total billed charges,458.16,92,,,percent of total billed charges,92% of total billed charges,159.36,458.16,
CL TX TRIMALLEOLOR ANKLE FX; W/MANIPU LT,1000366,CDM,450,RC,27818,HCPCS,Outpatient,,,957,813.45,,777.08,81.2,,,percent of total billed charges,81.2% of total billed charges,312.36,32.64,,,percent of total billed charges,32.64% of total billed charges,708.18,74,,,percent of total billed charges,74% of total billed charges,708.18,74,,,percent of total billed charges,74% of total billed charges,306.24,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.24,32,,,percent of total billed charges,32% of total billed charges,679.47,71,,,percent of total billed charges,71% of total billed charges,679.47,71,,,percent of total billed charges,71% of total billed charges,641.19,67,,,percent of total billed charges,67% of total billed charges,641.19,67,,,percent of total billed charges,67% of total billed charges,679.47,71,,,percent of total billed charges,71% of total billed charges,727.32,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,315.43,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,861.3,90,,,percent of total billed charges,90% of total billed charges,861.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,847.9,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.24,32,,,percent of total billed charges,32% of total billed charges,765.6,80,,,percent of total billed charges,80% of total billed charges,765.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,870.87,91,,,percent of total billed charges,91% of total billed charges,312.36,32.64,,,percent of total billed charges,32.64% of total billed charges,306.24,32,,,percent of total billed charges,32% of total billed charges,321.55,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.24,32,,,percent of total billed charges,32% of total billed charges,306.24,32,,,percent of total billed charges,32% of total billed charges,880.44,92,,,percent of total billed charges,92% of total billed charges,181.79,880.44,
CL TX TRIMALLEOLOR ANKLE FX; W/MANIPU RT,1000367,CDM,450,RC,27818,HCPCS,Outpatient,,,957,813.45,,777.08,81.2,,,percent of total billed charges,81.2% of total billed charges,312.36,32.64,,,percent of total billed charges,32.64% of total billed charges,708.18,74,,,percent of total billed charges,74% of total billed charges,708.18,74,,,percent of total billed charges,74% of total billed charges,306.24,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.24,32,,,percent of total billed charges,32% of total billed charges,679.47,71,,,percent of total billed charges,71% of total billed charges,679.47,71,,,percent of total billed charges,71% of total billed charges,641.19,67,,,percent of total billed charges,67% of total billed charges,641.19,67,,,percent of total billed charges,67% of total billed charges,679.47,71,,,percent of total billed charges,71% of total billed charges,727.32,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,315.43,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,861.3,90,,,percent of total billed charges,90% of total billed charges,861.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,847.9,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.24,32,,,percent of total billed charges,32% of total billed charges,765.6,80,,,percent of total billed charges,80% of total billed charges,765.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,870.87,91,,,percent of total billed charges,91% of total billed charges,312.36,32.64,,,percent of total billed charges,32.64% of total billed charges,306.24,32,,,percent of total billed charges,32% of total billed charges,321.55,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,306.24,32,,,percent of total billed charges,32% of total billed charges,306.24,32,,,percent of total billed charges,32% of total billed charges,880.44,92,,,percent of total billed charges,92% of total billed charges,181.79,880.44,
CL TX TRIMALLEOLOR ANKLE FX; W/MANIPU BL,1000368,CDM,450,RC,27818,HCPCS,Outpatient,,,1436,1220.6,,1166.03,81.2,,,percent of total billed charges,81.2% of total billed charges,468.71,32.64,,,percent of total billed charges,32.64% of total billed charges,1062.64,74,,,percent of total billed charges,74% of total billed charges,1062.64,74,,,percent of total billed charges,74% of total billed charges,459.52,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,459.52,32,,,percent of total billed charges,32% of total billed charges,1019.56,71,,,percent of total billed charges,71% of total billed charges,1019.56,71,,,percent of total billed charges,71% of total billed charges,962.12,67,,,percent of total billed charges,67% of total billed charges,962.12,67,,,percent of total billed charges,67% of total billed charges,1019.56,71,,,percent of total billed charges,71% of total billed charges,1091.36,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,473.31,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1292.4,90,,,percent of total billed charges,90% of total billed charges,1292.4,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1272.3,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,459.52,32,,,percent of total billed charges,32% of total billed charges,1148.8,80,,,percent of total billed charges,80% of total billed charges,1148.8,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1306.76,91,,,percent of total billed charges,91% of total billed charges,468.71,32.64,,,percent of total billed charges,32.64% of total billed charges,459.52,32,,,percent of total billed charges,32% of total billed charges,482.5,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,459.52,32,,,percent of total billed charges,32% of total billed charges,459.52,32,,,percent of total billed charges,32% of total billed charges,1321.12,92,,,percent of total billed charges,92% of total billed charges,181.79,1321.12,
CL TX FX WT BEARING TIBIA W/WO A WTRX MA,1000193,CDM,450,RC,27825,HCPCS,Outpatient,,,1127,957.95,,915.12,81.2,,,percent of total billed charges,81.2% of total billed charges,367.85,32.64,,,percent of total billed charges,32.64% of total billed charges,833.98,74,,,percent of total billed charges,74% of total billed charges,833.98,74,,,percent of total billed charges,74% of total billed charges,360.64,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,360.64,32,,,percent of total billed charges,32% of total billed charges,800.17,71,,,percent of total billed charges,71% of total billed charges,800.17,71,,,percent of total billed charges,71% of total billed charges,755.09,67,,,percent of total billed charges,67% of total billed charges,755.09,67,,,percent of total billed charges,67% of total billed charges,800.17,71,,,percent of total billed charges,71% of total billed charges,856.52,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,371.46,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,1014.3,90,,,percent of total billed charges,90% of total billed charges,1014.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,998.52,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,360.64,32,,,percent of total billed charges,32% of total billed charges,901.6,80,,,percent of total billed charges,80% of total billed charges,901.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,1025.57,91,,,percent of total billed charges,91% of total billed charges,367.85,32.64,,,percent of total billed charges,32.64% of total billed charges,360.64,32,,,percent of total billed charges,32% of total billed charges,378.67,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,360.64,32,,,percent of total billed charges,32% of total billed charges,360.64,32,,,percent of total billed charges,32% of total billed charges,1036.84,92,,,percent of total billed charges,92% of total billed charges,181.79,1036.84,
CL TX ANKLE DISLOCAT WO ANESTHESIA LT,1000315,CDM,450,RC,27840,HCPCS,Outpatient,,,783,665.55,,635.8,81.2,,,percent of total billed charges,81.2% of total billed charges,255.57,32.64,,,percent of total billed charges,32.64% of total billed charges,579.42,74,,,percent of total billed charges,74% of total billed charges,579.42,74,,,percent of total billed charges,74% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,524.61,67,,,percent of total billed charges,67% of total billed charges,524.61,67,,,percent of total billed charges,67% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,595.08,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,258.08,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,704.7,90,,,percent of total billed charges,90% of total billed charges,704.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,693.74,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,626.4,80,,,percent of total billed charges,80% of total billed charges,626.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,712.53,91,,,percent of total billed charges,91% of total billed charges,255.57,32.64,,,percent of total billed charges,32.64% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,263.09,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,720.36,92,,,percent of total billed charges,92% of total billed charges,181.79,720.36,
CL TX ANKLE DISLOCAT WO ANESTHESIA RT,1000314,CDM,450,RC,27840,HCPCS,Outpatient,,,783,665.55,,635.8,81.2,,,percent of total billed charges,81.2% of total billed charges,255.57,32.64,,,percent of total billed charges,32.64% of total billed charges,579.42,74,,,percent of total billed charges,74% of total billed charges,579.42,74,,,percent of total billed charges,74% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,524.61,67,,,percent of total billed charges,67% of total billed charges,524.61,67,,,percent of total billed charges,67% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,595.08,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,258.08,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,704.7,90,,,percent of total billed charges,90% of total billed charges,704.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,693.74,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,626.4,80,,,percent of total billed charges,80% of total billed charges,626.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,712.53,91,,,percent of total billed charges,91% of total billed charges,255.57,32.64,,,percent of total billed charges,32.64% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,263.09,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,720.36,92,,,percent of total billed charges,92% of total billed charges,181.79,720.36,
CL TX ANKLE DISLOCAT W ANESTHESIA LT,1000317,CDM,450,RC,27842,HCPCS,Outpatient,,,783,665.55,,635.8,81.2,,,percent of total billed charges,81.2% of total billed charges,255.57,32.64,,,percent of total billed charges,32.64% of total billed charges,579.42,74,,,percent of total billed charges,74% of total billed charges,579.42,74,,,percent of total billed charges,74% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,524.61,67,,,percent of total billed charges,67% of total billed charges,524.61,67,,,percent of total billed charges,67% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,595.08,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,258.08,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,704.7,90,,,percent of total billed charges,90% of total billed charges,704.7,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,693.74,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,626.4,80,,,percent of total billed charges,80% of total billed charges,626.4,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,712.53,91,,,percent of total billed charges,91% of total billed charges,255.57,32.64,,,percent of total billed charges,32.64% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,263.09,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,720.36,92,,,percent of total billed charges,92% of total billed charges,250.56,720.36,
CL TX ANKLE DISLOCAT W ANESTHESIA RT,1000316,CDM,450,RC,27842,HCPCS,Outpatient,,,783,665.55,,635.8,81.2,,,percent of total billed charges,81.2% of total billed charges,255.57,32.64,,,percent of total billed charges,32.64% of total billed charges,579.42,74,,,percent of total billed charges,74% of total billed charges,579.42,74,,,percent of total billed charges,74% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,524.61,67,,,percent of total billed charges,67% of total billed charges,524.61,67,,,percent of total billed charges,67% of total billed charges,555.93,71,,,percent of total billed charges,71% of total billed charges,595.08,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,258.08,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,704.7,90,,,percent of total billed charges,90% of total billed charges,704.7,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,693.74,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,626.4,80,,,percent of total billed charges,80% of total billed charges,626.4,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,712.53,91,,,percent of total billed charges,91% of total billed charges,255.57,32.64,,,percent of total billed charges,32.64% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,263.09,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,250.56,32,,,percent of total billed charges,32% of total billed charges,250.56,32,,,percent of total billed charges,32% of total billed charges,720.36,92,,,percent of total billed charges,92% of total billed charges,250.56,720.36,
"REMOVAL FOREIGN BODY, FT SUBCUTANEOUS LT",1000281,CDM,450,RC,28190,HCPCS,Outpatient,,,334,283.9,,271.21,81.2,,,percent of total billed charges,81.2% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,253.84,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,110.09,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,295.92,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,303.94,91,,,percent of total billed charges,91% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,112.22,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,307.28,92,,,percent of total billed charges,92% of total billed charges,106.88,307.28,
"REMOVAL FOREIGN BODY, FT SUBCUTANEOUS RT",1000280,CDM,450,RC,28190,HCPCS,Outpatient,,,334,283.9,,271.21,81.2,,,percent of total billed charges,81.2% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,253.84,76,,,percent of total billed charges,76% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,110.09,32.96,,,percent of total billed charges,32.96% of total billed charges,251.85,105,,,Fee Schedule,pays based on EAPG rates,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,295.92,88.6,,,percent of total billed charges,88.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,239.85,100,,,Fee Schedule,pays based on EAPG rates,303.94,91,,,percent of total billed charges,91% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,112.22,33.6,,,percent of total billed charges,33.6% of total billed charges,247.05,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,307.28,92,,,percent of total billed charges,92% of total billed charges,106.88,307.28,
"REMOVAL FOREIGN BODY FOOT, DEEP LT",1000283,CDM,450,RC,28192,HCPCS,Outpatient,,,789,670.65,,640.67,81.2,,,percent of total billed charges,81.2% of total billed charges,257.53,32.64,,,percent of total billed charges,32.64% of total billed charges,583.86,74,,,percent of total billed charges,74% of total billed charges,583.86,74,,,percent of total billed charges,74% of total billed charges,252.48,32,,,percent of total billed charges,32% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,252.48,32,,,percent of total billed charges,32% of total billed charges,560.19,71,,,percent of total billed charges,71% of total billed charges,560.19,71,,,percent of total billed charges,71% of total billed charges,528.63,67,,,percent of total billed charges,67% of total billed charges,528.63,67,,,percent of total billed charges,67% of total billed charges,560.19,71,,,percent of total billed charges,71% of total billed charges,599.64,76,,,percent of total billed charges,76% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,260.05,32.96,,,percent of total billed charges,32.96% of total billed charges,874.03,105,,,Fee Schedule,pays based on EAPG rates,710.1,90,,,percent of total billed charges,90% of total billed charges,710.1,90,,,percent of total billed charges,90% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,699.05,88.6,,,percent of total billed charges,88.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,252.48,32,,,percent of total billed charges,32% of total billed charges,631.2,80,,,percent of total billed charges,80% of total billed charges,631.2,80,,,percent of total billed charges,80% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,717.99,91,,,percent of total billed charges,91% of total billed charges,257.53,32.64,,,percent of total billed charges,32.64% of total billed charges,252.48,32,,,percent of total billed charges,32% of total billed charges,265.1,33.6,,,percent of total billed charges,33.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,252.48,32,,,percent of total billed charges,32% of total billed charges,252.48,32,,,percent of total billed charges,32% of total billed charges,725.88,92,,,percent of total billed charges,92% of total billed charges,252.48,874.03,
"REMOVAL FOREIGN BODY FOOT, DEEP RT",1000282,CDM,450,RC,28192,HCPCS,Outpatient,,,789,670.65,,640.67,81.2,,,percent of total billed charges,81.2% of total billed charges,257.53,32.64,,,percent of total billed charges,32.64% of total billed charges,583.86,74,,,percent of total billed charges,74% of total billed charges,583.86,74,,,percent of total billed charges,74% of total billed charges,252.48,32,,,percent of total billed charges,32% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,252.48,32,,,percent of total billed charges,32% of total billed charges,560.19,71,,,percent of total billed charges,71% of total billed charges,560.19,71,,,percent of total billed charges,71% of total billed charges,528.63,67,,,percent of total billed charges,67% of total billed charges,528.63,67,,,percent of total billed charges,67% of total billed charges,560.19,71,,,percent of total billed charges,71% of total billed charges,599.64,76,,,percent of total billed charges,76% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,260.05,32.96,,,percent of total billed charges,32.96% of total billed charges,874.03,105,,,Fee Schedule,pays based on EAPG rates,710.1,90,,,percent of total billed charges,90% of total billed charges,710.1,90,,,percent of total billed charges,90% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,699.05,88.6,,,percent of total billed charges,88.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,252.48,32,,,percent of total billed charges,32% of total billed charges,631.2,80,,,percent of total billed charges,80% of total billed charges,631.2,80,,,percent of total billed charges,80% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,717.99,91,,,percent of total billed charges,91% of total billed charges,257.53,32.64,,,percent of total billed charges,32.64% of total billed charges,252.48,32,,,percent of total billed charges,32% of total billed charges,265.1,33.6,,,percent of total billed charges,33.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,252.48,32,,,percent of total billed charges,32% of total billed charges,252.48,32,,,percent of total billed charges,32% of total billed charges,725.88,92,,,percent of total billed charges,92% of total billed charges,252.48,874.03,
"REMOVAL FOREIGN BODY FOOT, DEEP",1000158,CDM,450,RC,28192,HCPCS,Outpatient,,,1184,1006.4,,961.41,81.2,,,percent of total billed charges,81.2% of total billed charges,386.46,32.64,,,percent of total billed charges,32.64% of total billed charges,876.16,74,,,percent of total billed charges,74% of total billed charges,876.16,74,,,percent of total billed charges,74% of total billed charges,378.88,32,,,percent of total billed charges,32% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,378.88,32,,,percent of total billed charges,32% of total billed charges,840.64,71,,,percent of total billed charges,71% of total billed charges,840.64,71,,,percent of total billed charges,71% of total billed charges,793.28,67,,,percent of total billed charges,67% of total billed charges,793.28,67,,,percent of total billed charges,67% of total billed charges,840.64,71,,,percent of total billed charges,71% of total billed charges,899.84,76,,,percent of total billed charges,76% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,390.25,32.96,,,percent of total billed charges,32.96% of total billed charges,874.03,105,,,Fee Schedule,pays based on EAPG rates,1065.6,90,,,percent of total billed charges,90% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,1049.02,88.6,,,percent of total billed charges,88.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,378.88,32,,,percent of total billed charges,32% of total billed charges,947.2,80,,,percent of total billed charges,80% of total billed charges,947.2,80,,,percent of total billed charges,80% of total billed charges,832.41,100,,,Fee Schedule,pays based on EAPG rates,1077.44,91,,,percent of total billed charges,91% of total billed charges,386.46,32.64,,,percent of total billed charges,32.64% of total billed charges,378.88,32,,,percent of total billed charges,32% of total billed charges,397.82,33.6,,,percent of total billed charges,33.6% of total billed charges,857.38,103,,,Fee Schedule,pays based on EAPG rates,378.88,32,,,percent of total billed charges,32% of total billed charges,378.88,32,,,percent of total billed charges,32% of total billed charges,1089.28,92,,,percent of total billed charges,92% of total billed charges,378.88,1089.28,
REMOVAL FOREIGN BODY FOOT COMPLICATED LT,1000285,CDM,450,RC,28193,HCPCS,Outpatient,,,975,828.75,,791.7,81.2,,,percent of total billed charges,81.2% of total billed charges,318.24,32.64,,,percent of total billed charges,32.64% of total billed charges,721.5,74,,,percent of total billed charges,74% of total billed charges,721.5,74,,,percent of total billed charges,74% of total billed charges,312,32,,,percent of total billed charges,32% of total billed charges,1113.5,103,,,Fee Schedule,pays based on EAPG rates,312,32,,,percent of total billed charges,32% of total billed charges,692.25,71,,,percent of total billed charges,71% of total billed charges,692.25,71,,,percent of total billed charges,71% of total billed charges,653.25,67,,,percent of total billed charges,67% of total billed charges,653.25,67,,,percent of total billed charges,67% of total billed charges,692.25,71,,,percent of total billed charges,71% of total billed charges,741,76,,,percent of total billed charges,76% of total billed charges,1113.5,103,,,Fee Schedule,pays based on EAPG rates,321.36,32.96,,,percent of total billed charges,32.96% of total billed charges,1135.12,105,,,Fee Schedule,pays based on EAPG rates,877.5,90,,,percent of total billed charges,90% of total billed charges,877.5,90,,,percent of total billed charges,90% of total billed charges,1081.06,100,,,Fee Schedule,pays based on EAPG rates,863.85,88.6,,,percent of total billed charges,88.6% of total billed charges,1113.5,103,,,Fee Schedule,pays based on EAPG rates,312,32,,,percent of total billed charges,32% of total billed charges,780,80,,,percent of total billed charges,80% of total billed charges,780,80,,,percent of total billed charges,80% of total billed charges,1081.06,100,,,Fee Schedule,pays based on EAPG rates,887.25,91,,,percent of total billed charges,91% of total billed charges,318.24,32.64,,,percent of total billed charges,32.64% of total billed charges,312,32,,,percent of total billed charges,32% of total billed charges,327.6,33.6,,,percent of total billed charges,33.6% of total billed charges,1113.5,103,,,Fee Schedule,pays based on EAPG rates,312,32,,,percent of total billed charges,32% of total billed charges,312,32,,,percent of total billed charges,32% of total billed charges,897,92,,,percent of total billed charges,92% of total billed charges,312,1135.12,
REMOVAL FOREIGN BODY FOOT COMPLICATED RT,1000284,CDM,450,RC,28193,HCPCS,Outpatient,,,975,828.75,,791.7,81.2,,,percent of total billed charges,81.2% of total billed charges,318.24,32.64,,,percent of total billed charges,32.64% of total billed charges,721.5,74,,,percent of total billed charges,74% of total billed charges,721.5,74,,,percent of total billed charges,74% of total billed charges,312,32,,,percent of total billed charges,32% of total billed charges,1113.5,103,,,Fee Schedule,pays based on EAPG rates,312,32,,,percent of total billed charges,32% of total billed charges,692.25,71,,,percent of total billed charges,71% of total billed charges,692.25,71,,,percent of total billed charges,71% of total billed charges,653.25,67,,,percent of total billed charges,67% of total billed charges,653.25,67,,,percent of total billed charges,67% of total billed charges,692.25,71,,,percent of total billed charges,71% of total billed charges,741,76,,,percent of total billed charges,76% of total billed charges,1113.5,103,,,Fee Schedule,pays based on EAPG rates,321.36,32.96,,,percent of total billed charges,32.96% of total billed charges,1135.12,105,,,Fee Schedule,pays based on EAPG rates,877.5,90,,,percent of total billed charges,90% of total billed charges,877.5,90,,,percent of total billed charges,90% of total billed charges,1081.06,100,,,Fee Schedule,pays based on EAPG rates,863.85,88.6,,,percent of total billed charges,88.6% of total billed charges,1113.5,103,,,Fee Schedule,pays based on EAPG rates,312,32,,,percent of total billed charges,32% of total billed charges,780,80,,,percent of total billed charges,80% of total billed charges,780,80,,,percent of total billed charges,80% of total billed charges,1081.06,100,,,Fee Schedule,pays based on EAPG rates,887.25,91,,,percent of total billed charges,91% of total billed charges,318.24,32.64,,,percent of total billed charges,32.64% of total billed charges,312,32,,,percent of total billed charges,32% of total billed charges,327.6,33.6,,,percent of total billed charges,33.6% of total billed charges,1113.5,103,,,Fee Schedule,pays based on EAPG rates,312,32,,,percent of total billed charges,32% of total billed charges,312,32,,,percent of total billed charges,32% of total billed charges,897,92,,,percent of total billed charges,92% of total billed charges,312,1135.12,
CLOSED TX OF TALUS FX; WITH MANIPULATION,1000199,CDM,450,RC,28435,HCPCS,Outpatient,,,594,504.9,,482.33,81.2,,,percent of total billed charges,81.2% of total billed charges,193.88,32.64,,,percent of total billed charges,32.64% of total billed charges,439.56,74,,,percent of total billed charges,74% of total billed charges,439.56,74,,,percent of total billed charges,74% of total billed charges,190.08,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,190.08,32,,,percent of total billed charges,32% of total billed charges,421.74,71,,,percent of total billed charges,71% of total billed charges,421.74,71,,,percent of total billed charges,71% of total billed charges,397.98,67,,,percent of total billed charges,67% of total billed charges,397.98,67,,,percent of total billed charges,67% of total billed charges,421.74,71,,,percent of total billed charges,71% of total billed charges,451.44,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,195.78,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,534.6,90,,,percent of total billed charges,90% of total billed charges,534.6,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,526.28,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,190.08,32,,,percent of total billed charges,32% of total billed charges,475.2,80,,,percent of total billed charges,80% of total billed charges,475.2,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,540.54,91,,,percent of total billed charges,91% of total billed charges,193.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.08,32,,,percent of total billed charges,32% of total billed charges,199.58,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,190.08,32,,,percent of total billed charges,32% of total billed charges,190.08,32,,,percent of total billed charges,32% of total billed charges,546.48,92,,,percent of total billed charges,92% of total billed charges,181.79,546.48,
"CL TX OF FX OF GREAT TOE, PHALANX OR PHA",1000206,CDM,450,RC,28490,HCPCS,Outpatient,,,197,167.45,,159.96,81.2,,,percent of total billed charges,81.2% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,149.72,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,64.93,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,174.54,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,179.27,91,,,percent of total billed charges,91% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,66.19,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,181.24,92,,,percent of total billed charges,92% of total billed charges,63.04,190.88,
CL TX FX GRT TOE PHLX/PHLG W/MANJ LT,1000245,CDM,450,RC,28495,HCPCS,Outpatient,,,273,232.05,,221.68,81.2,,,percent of total billed charges,81.2% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,207.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,89.98,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,245.7,90,,,percent of total billed charges,90% of total billed charges,245.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,241.88,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,248.43,91,,,percent of total billed charges,91% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,91.73,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,251.16,92,,,percent of total billed charges,92% of total billed charges,87.36,251.16,
CL TX FX GRT TOE PHLX/PHLG W/MANJ RT,1000246,CDM,450,RC,28495,HCPCS,Outpatient,,,273,232.05,,221.68,81.2,,,percent of total billed charges,81.2% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,207.48,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,89.98,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,245.7,90,,,percent of total billed charges,90% of total billed charges,245.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,241.88,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,248.43,91,,,percent of total billed charges,91% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,91.73,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,251.16,92,,,percent of total billed charges,92% of total billed charges,87.36,251.16,
"CL TX OF FX, PHALAN X, OTHER THAN GR TOE",1000200,CDM,450,RC,28510,HCPCS,Outpatient,,,197,167.45,,159.96,81.2,,,percent of total billed charges,81.2% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,149.72,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,64.93,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,174.54,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,179.27,91,,,percent of total billed charges,91% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,66.19,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,181.24,92,,,percent of total billed charges,92% of total billed charges,63.04,190.88,
CL TX FX PHALANX NOT GREAT TOE W/ MAN,1000233,CDM,450,RC,28515,HCPCS,Outpatient,,,255,216.75,,207.06,81.2,,,percent of total billed charges,81.2% of total billed charges,83.23,32.64,,,percent of total billed charges,32.64% of total billed charges,188.7,74,,,percent of total billed charges,74% of total billed charges,188.7,74,,,percent of total billed charges,74% of total billed charges,81.6,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,81.6,32,,,percent of total billed charges,32% of total billed charges,181.05,71,,,percent of total billed charges,71% of total billed charges,181.05,71,,,percent of total billed charges,71% of total billed charges,170.85,67,,,percent of total billed charges,67% of total billed charges,170.85,67,,,percent of total billed charges,67% of total billed charges,181.05,71,,,percent of total billed charges,71% of total billed charges,193.8,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,84.05,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,229.5,90,,,percent of total billed charges,90% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,225.93,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,81.6,32,,,percent of total billed charges,32% of total billed charges,204,80,,,percent of total billed charges,80% of total billed charges,204,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,232.05,91,,,percent of total billed charges,91% of total billed charges,83.23,32.64,,,percent of total billed charges,32.64% of total billed charges,81.6,32,,,percent of total billed charges,32% of total billed charges,85.68,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,81.6,32,,,percent of total billed charges,32% of total billed charges,81.6,32,,,percent of total billed charges,32% of total billed charges,234.6,92,,,percent of total billed charges,92% of total billed charges,81.6,234.6,
CL TX TARSOMETATARSAL JNT DSLCT W/ ANES,1000414,CDM,450,RC,28605,HCPCS,Outpatient,,,1107,940.95,,898.88,81.2,,,percent of total billed charges,81.2% of total billed charges,361.32,32.64,,,percent of total billed charges,32.64% of total billed charges,819.18,74,,,percent of total billed charges,74% of total billed charges,819.18,74,,,percent of total billed charges,74% of total billed charges,354.24,32,,,percent of total billed charges,32% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,354.24,32,,,percent of total billed charges,32% of total billed charges,785.97,71,,,percent of total billed charges,71% of total billed charges,785.97,71,,,percent of total billed charges,71% of total billed charges,741.69,67,,,percent of total billed charges,67% of total billed charges,741.69,67,,,percent of total billed charges,67% of total billed charges,785.97,71,,,percent of total billed charges,71% of total billed charges,841.32,76,,,percent of total billed charges,76% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,364.87,32.96,,,percent of total billed charges,32.96% of total billed charges,533.42,105,,,Fee Schedule,pays based on EAPG rates,996.3,90,,,percent of total billed charges,90% of total billed charges,996.3,90,,,percent of total billed charges,90% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,980.8,88.6,,,percent of total billed charges,88.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,354.24,32,,,percent of total billed charges,32% of total billed charges,885.6,80,,,percent of total billed charges,80% of total billed charges,885.6,80,,,percent of total billed charges,80% of total billed charges,508.02,100,,,Fee Schedule,pays based on EAPG rates,1007.37,91,,,percent of total billed charges,91% of total billed charges,361.32,32.64,,,percent of total billed charges,32.64% of total billed charges,354.24,32,,,percent of total billed charges,32% of total billed charges,371.95,33.6,,,percent of total billed charges,33.6% of total billed charges,523.26,103,,,Fee Schedule,pays based on EAPG rates,354.24,32,,,percent of total billed charges,32% of total billed charges,354.24,32,,,percent of total billed charges,32% of total billed charges,1018.44,92,,,percent of total billed charges,92% of total billed charges,354.24,1018.44,
CL TX MTP JNT DSLCTN W/O ANES,1000380,CDM,450,RC,28630,HCPCS,Outpatient,,,833,708.05,,676.4,81.2,,,percent of total billed charges,81.2% of total billed charges,271.89,32.64,,,percent of total billed charges,32.64% of total billed charges,616.42,74,,,percent of total billed charges,74% of total billed charges,616.42,74,,,percent of total billed charges,74% of total billed charges,266.56,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.56,32,,,percent of total billed charges,32% of total billed charges,591.43,71,,,percent of total billed charges,71% of total billed charges,591.43,71,,,percent of total billed charges,71% of total billed charges,558.11,67,,,percent of total billed charges,67% of total billed charges,558.11,67,,,percent of total billed charges,67% of total billed charges,591.43,71,,,percent of total billed charges,71% of total billed charges,633.08,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,274.56,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,749.7,90,,,percent of total billed charges,90% of total billed charges,749.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,738.04,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.56,32,,,percent of total billed charges,32% of total billed charges,666.4,80,,,percent of total billed charges,80% of total billed charges,666.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,758.03,91,,,percent of total billed charges,91% of total billed charges,271.89,32.64,,,percent of total billed charges,32.64% of total billed charges,266.56,32,,,percent of total billed charges,32% of total billed charges,279.89,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,266.56,32,,,percent of total billed charges,32% of total billed charges,266.56,32,,,percent of total billed charges,32% of total billed charges,766.36,92,,,percent of total billed charges,92% of total billed charges,181.79,766.36,
CL TX INTERPHALANGEAL JNT DSLCTN; WO ANT,1000218,CDM,450,RC,28660,HCPCS,Outpatient,,,218,185.3,,177.02,81.2,,,percent of total billed charges,81.2% of total billed charges,71.16,32.64,,,percent of total billed charges,32.64% of total billed charges,161.32,74,,,percent of total billed charges,74% of total billed charges,161.32,74,,,percent of total billed charges,74% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,146.06,67,,,percent of total billed charges,67% of total billed charges,146.06,67,,,percent of total billed charges,67% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,165.68,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,71.85,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,196.2,90,,,percent of total billed charges,90% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,193.15,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,174.4,80,,,percent of total billed charges,80% of total billed charges,174.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,198.38,91,,,percent of total billed charges,91% of total billed charges,71.16,32.64,,,percent of total billed charges,32.64% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,73.25,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,200.56,92,,,percent of total billed charges,92% of total billed charges,69.76,200.56,
APP LONG ARM SPLINT (SHOULDER-HAND) LT,1000287,CDM,450,RC,29105,HCPCS,Outpatient,,,148,125.8,,120.18,81.2,,,percent of total billed charges,81.2% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,112.48,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,48.78,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,133.2,90,,,percent of total billed charges,90% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,131.13,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,134.68,91,,,percent of total billed charges,91% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,49.73,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,136.16,92,,,percent of total billed charges,92% of total billed charges,34.79,136.16,
APP LONG ARM SPLINT (SHOULDER-HAND) RT,1000286,CDM,450,RC,29105,HCPCS,Outpatient,,,148,125.8,,120.18,81.2,,,percent of total billed charges,81.2% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,112.48,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,48.78,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,133.2,90,,,percent of total billed charges,90% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,131.13,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,134.68,91,,,percent of total billed charges,91% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,49.73,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,136.16,92,,,percent of total billed charges,92% of total billed charges,34.79,136.16,
APP SHRT ARM SPLNT (FRAR-HAND);STATIC LT,1000289,CDM,450,RC,29125,HCPCS,Outpatient,,,100,85,,81.2,81.2,,,percent of total billed charges,81.2% of total billed charges,32.64,32.64,,,percent of total billed charges,32.64% of total billed charges,74,74,,,percent of total billed charges,74% of total billed charges,74,74,,,percent of total billed charges,74% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,32,32,,,percent of total billed charges,32% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,67,67,,,percent of total billed charges,67% of total billed charges,67,67,,,percent of total billed charges,67% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,76,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,32.96,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,88.6,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,32,32,,,percent of total billed charges,32% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,91,91,,,percent of total billed charges,91% of total billed charges,32.64,32.64,,,percent of total billed charges,32.64% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,33.6,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,32,32,,,percent of total billed charges,32% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,92,92,,,percent of total billed charges,92% of total billed charges,32,92,
APP SHRT ARM SPLNT (FRAR-HAND);STATIC RT,1000288,CDM,450,RC,29125,HCPCS,Outpatient,,,100,85,,81.2,81.2,,,percent of total billed charges,81.2% of total billed charges,32.64,32.64,,,percent of total billed charges,32.64% of total billed charges,74,74,,,percent of total billed charges,74% of total billed charges,74,74,,,percent of total billed charges,74% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,32,32,,,percent of total billed charges,32% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,67,67,,,percent of total billed charges,67% of total billed charges,67,67,,,percent of total billed charges,67% of total billed charges,71,71,,,percent of total billed charges,71% of total billed charges,76,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,32.96,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,88.6,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,32,32,,,percent of total billed charges,32% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,80,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,91,91,,,percent of total billed charges,91% of total billed charges,32.64,32.64,,,percent of total billed charges,32.64% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,33.6,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,32,32,,,percent of total billed charges,32% of total billed charges,32,32,,,percent of total billed charges,32% of total billed charges,92,92,,,percent of total billed charges,92% of total billed charges,32,92,
APP SHRT ARM SPLNT (FRAR-HAND);STATIC BL,1000439,CDM,450,RC,29125,HCPCS,Outpatient,,,151,128.35,,122.61,81.2,,,percent of total billed charges,81.2% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,114.76,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,49.77,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,133.79,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,137.41,91,,,percent of total billed charges,91% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,50.74,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,138.92,92,,,percent of total billed charges,92% of total billed charges,34.79,138.92,
APP FINGER SPLINT;STATIC LT 2ND DIGIT,1000392,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
APP FINGER SPLINT;STATIC LT 3RD DIGIT,1000393,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
APP FINGER SPLINT;STATIC LT 4TH DIGIT,1000394,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
APP FINGER SPLINT;STATIC LT 5TH DIGIT,1000395,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
APP FINGER SPLINT;STATIC LT THUMB,1000401,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
APP FINGER SPLINT;STATIC RT 2ND DIGIT,1000397,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
APP FINGER SPLINT;STATIC RT 3RD DIGIT,1000398,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
APP FINGER SPLINT;STATIC RT 4TH DIGIT,1000399,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
APP FINGER SPLINT;STATIC RT 5TH DIGIT,1000400,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
APP FINGER SPLINT;STATIC RT THUMB,1000396,CDM,450,RC,29130,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,26.88,77.28,
STRAPPING; SHOULDER LT,1000427,CDM,450,RC,29240,HCPCS,Outpatient,,,121,102.85,,98.25,81.2,,,percent of total billed charges,81.2% of total billed charges,39.49,32.64,,,percent of total billed charges,32.64% of total billed charges,89.54,74,,,percent of total billed charges,74% of total billed charges,89.54,74,,,percent of total billed charges,74% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,81.07,67,,,percent of total billed charges,67% of total billed charges,81.07,67,,,percent of total billed charges,67% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,91.96,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,39.88,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,108.9,90,,,percent of total billed charges,90% of total billed charges,108.9,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,107.21,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,96.8,80,,,percent of total billed charges,80% of total billed charges,96.8,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,110.11,91,,,percent of total billed charges,91% of total billed charges,39.49,32.64,,,percent of total billed charges,32.64% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,40.66,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,111.32,92,,,percent of total billed charges,92% of total billed charges,34.79,111.32,
STRAPPING; SHOULDER RT,1000428,CDM,450,RC,29240,HCPCS,Outpatient,,,121,102.85,,98.25,81.2,,,percent of total billed charges,81.2% of total billed charges,39.49,32.64,,,percent of total billed charges,32.64% of total billed charges,89.54,74,,,percent of total billed charges,74% of total billed charges,89.54,74,,,percent of total billed charges,74% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,81.07,67,,,percent of total billed charges,67% of total billed charges,81.07,67,,,percent of total billed charges,67% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,91.96,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,39.88,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,108.9,90,,,percent of total billed charges,90% of total billed charges,108.9,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,107.21,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,96.8,80,,,percent of total billed charges,80% of total billed charges,96.8,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,110.11,91,,,percent of total billed charges,91% of total billed charges,39.49,32.64,,,percent of total billed charges,32.64% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,40.66,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,111.32,92,,,percent of total billed charges,92% of total billed charges,34.79,111.32,
APPLICATION LONG LEG SPLINT LT,1000319,CDM,450,RC,29505,HCPCS,Outpatient,,,118,100.3,,95.82,81.2,,,percent of total billed charges,81.2% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,89.68,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,38.89,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,104.55,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,107.38,91,,,percent of total billed charges,91% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,39.65,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,108.56,92,,,percent of total billed charges,92% of total billed charges,34.79,108.56,
APPLICATION LONG LEG SPLINT RT,1000318,CDM,450,RC,29505,HCPCS,Outpatient,,,118,100.3,,95.82,81.2,,,percent of total billed charges,81.2% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,89.68,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,38.89,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,104.55,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,107.38,91,,,percent of total billed charges,91% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,39.65,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,108.56,92,,,percent of total billed charges,92% of total billed charges,34.79,108.56,
APPLICATION SHORT LEG SPLINT LT,1000321,CDM,450,RC,29515,HCPCS,Outpatient,,,124,105.4,,100.69,81.2,,,percent of total billed charges,81.2% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,94.24,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,40.87,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,109.86,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,112.84,91,,,percent of total billed charges,91% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,41.66,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,114.08,92,,,percent of total billed charges,92% of total billed charges,34.79,114.08,
APPLICATION SHORT LEG SPLINT RT,1000320,CDM,450,RC,29515,HCPCS,Outpatient,,,124,105.4,,100.69,81.2,,,percent of total billed charges,81.2% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,94.24,76,,,percent of total billed charges,76% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,40.87,32.96,,,percent of total billed charges,32.96% of total billed charges,36.53,105,,,Fee Schedule,pays based on EAPG rates,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,109.86,88.6,,,percent of total billed charges,88.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,34.79,100,,,Fee Schedule,pays based on EAPG rates,112.84,91,,,percent of total billed charges,91% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,41.66,33.6,,,percent of total billed charges,33.6% of total billed charges,35.83,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,114.08,92,,,percent of total billed charges,92% of total billed charges,34.79,114.08,
RMVL FB INTRANASAL OFC TYPE PROCEDURE,1000162,CDM,450,RC,30300,HCPCS,Outpatient,,,380,323,,308.56,81.2,,,percent of total billed charges,81.2% of total billed charges,124.03,32.64,,,percent of total billed charges,32.64% of total billed charges,281.2,74,,,percent of total billed charges,74% of total billed charges,281.2,74,,,percent of total billed charges,74% of total billed charges,121.6,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,121.6,32,,,percent of total billed charges,32% of total billed charges,269.8,71,,,percent of total billed charges,71% of total billed charges,269.8,71,,,percent of total billed charges,71% of total billed charges,254.6,67,,,percent of total billed charges,67% of total billed charges,254.6,67,,,percent of total billed charges,67% of total billed charges,269.8,71,,,percent of total billed charges,71% of total billed charges,288.8,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,125.25,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,342,90,,,percent of total billed charges,90% of total billed charges,342,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,336.68,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,121.6,32,,,percent of total billed charges,32% of total billed charges,304,80,,,percent of total billed charges,80% of total billed charges,304,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,345.8,91,,,percent of total billed charges,91% of total billed charges,124.03,32.64,,,percent of total billed charges,32.64% of total billed charges,121.6,32,,,percent of total billed charges,32% of total billed charges,127.68,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,121.6,32,,,percent of total billed charges,32% of total billed charges,121.6,32,,,percent of total billed charges,32% of total billed charges,349.6,92,,,percent of total billed charges,92% of total billed charges,66.31,349.6,
CONTROL NASAL HEMORRHAGE ANTR SIMPLE LT,1000328,CDM,450,RC,30901,HCPCS,Outpatient,,,219,186.15,,177.83,81.2,,,percent of total billed charges,81.2% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,166.44,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,72.18,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,197.1,90,,,percent of total billed charges,90% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,194.03,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,199.29,91,,,percent of total billed charges,91% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,73.58,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,201.48,92,,,percent of total billed charges,92% of total billed charges,66.31,201.48,
CONTROL NASAL HEMORRHAGE ANTR SIMPLE RT,1000327,CDM,450,RC,30901,HCPCS,Outpatient,,,219,186.15,,177.83,81.2,,,percent of total billed charges,81.2% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,166.44,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,72.18,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,197.1,90,,,percent of total billed charges,90% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,194.03,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,199.29,91,,,percent of total billed charges,91% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,73.58,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,201.48,92,,,percent of total billed charges,92% of total billed charges,66.31,201.48,
CONTROL NASAL HEMORRHAGE ANTR SIMPLE BIL,1000277,CDM,450,RC,30901,HCPCS,Outpatient,,,326,277.1,,264.71,81.2,,,percent of total billed charges,81.2% of total billed charges,106.41,32.64,,,percent of total billed charges,32.64% of total billed charges,241.24,74,,,percent of total billed charges,74% of total billed charges,241.24,74,,,percent of total billed charges,74% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,218.42,67,,,percent of total billed charges,67% of total billed charges,218.42,67,,,percent of total billed charges,67% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,247.76,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,107.45,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,293.4,90,,,percent of total billed charges,90% of total billed charges,293.4,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,288.84,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,260.8,80,,,percent of total billed charges,80% of total billed charges,260.8,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,296.66,91,,,percent of total billed charges,91% of total billed charges,106.41,32.64,,,percent of total billed charges,32.64% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,109.54,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,299.92,92,,,percent of total billed charges,92% of total billed charges,66.31,299.92,
CNTRL NASAL HEMORRHAGE ANTER CMPLX LT,1000330,CDM,450,RC,30903,HCPCS,Outpatient,,,287,243.95,,233.04,81.2,,,percent of total billed charges,81.2% of total billed charges,93.68,32.64,,,percent of total billed charges,32.64% of total billed charges,212.38,74,,,percent of total billed charges,74% of total billed charges,212.38,74,,,percent of total billed charges,74% of total billed charges,91.84,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,91.84,32,,,percent of total billed charges,32% of total billed charges,203.77,71,,,percent of total billed charges,71% of total billed charges,203.77,71,,,percent of total billed charges,71% of total billed charges,192.29,67,,,percent of total billed charges,67% of total billed charges,192.29,67,,,percent of total billed charges,67% of total billed charges,203.77,71,,,percent of total billed charges,71% of total billed charges,218.12,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,94.6,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,258.3,90,,,percent of total billed charges,90% of total billed charges,258.3,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,254.28,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,91.84,32,,,percent of total billed charges,32% of total billed charges,229.6,80,,,percent of total billed charges,80% of total billed charges,229.6,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,261.17,91,,,percent of total billed charges,91% of total billed charges,93.68,32.64,,,percent of total billed charges,32.64% of total billed charges,91.84,32,,,percent of total billed charges,32% of total billed charges,96.43,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,91.84,32,,,percent of total billed charges,32% of total billed charges,91.84,32,,,percent of total billed charges,32% of total billed charges,264.04,92,,,percent of total billed charges,92% of total billed charges,66.31,264.04,
CNTRL NASAL HEMORRHAGE ANTER CMPLX RT,1000329,CDM,450,RC,30903,HCPCS,Outpatient,,,287,243.95,,233.04,81.2,,,percent of total billed charges,81.2% of total billed charges,93.68,32.64,,,percent of total billed charges,32.64% of total billed charges,212.38,74,,,percent of total billed charges,74% of total billed charges,212.38,74,,,percent of total billed charges,74% of total billed charges,91.84,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,91.84,32,,,percent of total billed charges,32% of total billed charges,203.77,71,,,percent of total billed charges,71% of total billed charges,203.77,71,,,percent of total billed charges,71% of total billed charges,192.29,67,,,percent of total billed charges,67% of total billed charges,192.29,67,,,percent of total billed charges,67% of total billed charges,203.77,71,,,percent of total billed charges,71% of total billed charges,218.12,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,94.6,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,258.3,90,,,percent of total billed charges,90% of total billed charges,258.3,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,254.28,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,91.84,32,,,percent of total billed charges,32% of total billed charges,229.6,80,,,percent of total billed charges,80% of total billed charges,229.6,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,261.17,91,,,percent of total billed charges,91% of total billed charges,93.68,32.64,,,percent of total billed charges,32.64% of total billed charges,91.84,32,,,percent of total billed charges,32% of total billed charges,96.43,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,91.84,32,,,percent of total billed charges,32% of total billed charges,91.84,32,,,percent of total billed charges,32% of total billed charges,264.04,92,,,percent of total billed charges,92% of total billed charges,66.31,264.04,
CONTROL NASAL HEMORRHAGE ANTERIOR CMPLX,1000164,CDM,450,RC,30903,HCPCS,Outpatient,,,287,243.95,,233.04,81.2,,,percent of total billed charges,81.2% of total billed charges,93.68,32.64,,,percent of total billed charges,32.64% of total billed charges,212.38,74,,,percent of total billed charges,74% of total billed charges,212.38,74,,,percent of total billed charges,74% of total billed charges,91.84,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,91.84,32,,,percent of total billed charges,32% of total billed charges,203.77,71,,,percent of total billed charges,71% of total billed charges,203.77,71,,,percent of total billed charges,71% of total billed charges,192.29,67,,,percent of total billed charges,67% of total billed charges,192.29,67,,,percent of total billed charges,67% of total billed charges,203.77,71,,,percent of total billed charges,71% of total billed charges,218.12,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,94.6,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,258.3,90,,,percent of total billed charges,90% of total billed charges,258.3,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,254.28,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,91.84,32,,,percent of total billed charges,32% of total billed charges,229.6,80,,,percent of total billed charges,80% of total billed charges,229.6,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,261.17,91,,,percent of total billed charges,91% of total billed charges,93.68,32.64,,,percent of total billed charges,32.64% of total billed charges,91.84,32,,,percent of total billed charges,32% of total billed charges,96.43,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,91.84,32,,,percent of total billed charges,32% of total billed charges,91.84,32,,,percent of total billed charges,32% of total billed charges,264.04,92,,,percent of total billed charges,92% of total billed charges,66.31,264.04,
CNTRL NASAL HEMORRHAGE ANTER CMPLX 50,1000331,CDM,450,RC,30903,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,66.31,396.52,
CNTRL NSL HMRRHG PSTR PACK/CAUT INITIAL,1000165,CDM,450,RC,30905,HCPCS,Outpatient,,,357,303.45,,289.88,81.2,,,percent of total billed charges,81.2% of total billed charges,116.52,32.64,,,percent of total billed charges,32.64% of total billed charges,264.18,74,,,percent of total billed charges,74% of total billed charges,264.18,74,,,percent of total billed charges,74% of total billed charges,114.24,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,114.24,32,,,percent of total billed charges,32% of total billed charges,253.47,71,,,percent of total billed charges,71% of total billed charges,253.47,71,,,percent of total billed charges,71% of total billed charges,239.19,67,,,percent of total billed charges,67% of total billed charges,239.19,67,,,percent of total billed charges,67% of total billed charges,253.47,71,,,percent of total billed charges,71% of total billed charges,271.32,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,117.67,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,321.3,90,,,percent of total billed charges,90% of total billed charges,321.3,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,316.3,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,114.24,32,,,percent of total billed charges,32% of total billed charges,285.6,80,,,percent of total billed charges,80% of total billed charges,285.6,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,324.87,91,,,percent of total billed charges,91% of total billed charges,116.52,32.64,,,percent of total billed charges,32.64% of total billed charges,114.24,32,,,percent of total billed charges,32% of total billed charges,119.95,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,114.24,32,,,percent of total billed charges,32% of total billed charges,114.24,32,,,percent of total billed charges,32% of total billed charges,328.44,92,,,percent of total billed charges,92% of total billed charges,66.31,328.44,
CONTROL NASAL HMRRHG PST SUBSEQ,1000270,CDM,450,RC,30906,HCPCS,Outpatient,,,346,294.1,,280.95,81.2,,,percent of total billed charges,81.2% of total billed charges,112.93,32.64,,,percent of total billed charges,32.64% of total billed charges,256.04,74,,,percent of total billed charges,74% of total billed charges,256.04,74,,,percent of total billed charges,74% of total billed charges,110.72,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,110.72,32,,,percent of total billed charges,32% of total billed charges,245.66,71,,,percent of total billed charges,71% of total billed charges,245.66,71,,,percent of total billed charges,71% of total billed charges,231.82,67,,,percent of total billed charges,67% of total billed charges,231.82,67,,,percent of total billed charges,67% of total billed charges,245.66,71,,,percent of total billed charges,71% of total billed charges,262.96,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,114.04,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,311.4,90,,,percent of total billed charges,90% of total billed charges,311.4,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,306.56,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,110.72,32,,,percent of total billed charges,32% of total billed charges,276.8,80,,,percent of total billed charges,80% of total billed charges,276.8,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,314.86,91,,,percent of total billed charges,91% of total billed charges,112.93,32.64,,,percent of total billed charges,32.64% of total billed charges,110.72,32,,,percent of total billed charges,32% of total billed charges,116.26,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,110.72,32,,,percent of total billed charges,32% of total billed charges,110.72,32,,,percent of total billed charges,32% of total billed charges,318.32,92,,,percent of total billed charges,92% of total billed charges,66.31,318.32,
INTUBATION ENDOTRACIAL ER PROCEDURE,1000166,CDM,450,RC,31500,HCPCS,Outpatient,,,361,306.85,,293.13,81.2,,,percent of total billed charges,81.2% of total billed charges,117.83,32.64,,,percent of total billed charges,32.64% of total billed charges,267.14,74,,,percent of total billed charges,74% of total billed charges,267.14,74,,,percent of total billed charges,74% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,241.87,67,,,percent of total billed charges,67% of total billed charges,241.87,67,,,percent of total billed charges,67% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,274.36,76,,,percent of total billed charges,76% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,118.99,32.96,,,percent of total billed charges,32.96% of total billed charges,391.37,105,,,Fee Schedule,pays based on EAPG rates,324.9,90,,,percent of total billed charges,90% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,372.73,100,,,Fee Schedule,pays based on EAPG rates,319.85,88.6,,,percent of total billed charges,88.6% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,288.8,80,,,percent of total billed charges,80% of total billed charges,288.8,80,,,percent of total billed charges,80% of total billed charges,372.73,100,,,Fee Schedule,pays based on EAPG rates,328.51,91,,,percent of total billed charges,91% of total billed charges,117.83,32.64,,,percent of total billed charges,32.64% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,121.3,33.6,,,percent of total billed charges,33.6% of total billed charges,383.91,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,332.12,92,,,percent of total billed charges,92% of total billed charges,115.52,391.37,
"TRACHEOSTOMY, ER PRCDR; CRICOTHYROID MEM",1000217,CDM,450,RC,31605,HCPCS,Outpatient,,,599,509.15,,486.39,81.2,,,percent of total billed charges,81.2% of total billed charges,195.51,32.64,,,percent of total billed charges,32.64% of total billed charges,443.26,74,,,percent of total billed charges,74% of total billed charges,443.26,74,,,percent of total billed charges,74% of total billed charges,191.68,32,,,percent of total billed charges,32% of total billed charges,1220.56,103,,,Fee Schedule,pays based on EAPG rates,191.68,32,,,percent of total billed charges,32% of total billed charges,425.29,71,,,percent of total billed charges,71% of total billed charges,425.29,71,,,percent of total billed charges,71% of total billed charges,401.33,67,,,percent of total billed charges,67% of total billed charges,401.33,67,,,percent of total billed charges,67% of total billed charges,425.29,71,,,percent of total billed charges,71% of total billed charges,455.24,76,,,percent of total billed charges,76% of total billed charges,1220.56,103,,,Fee Schedule,pays based on EAPG rates,197.43,32.96,,,percent of total billed charges,32.96% of total billed charges,1244.26,105,,,Fee Schedule,pays based on EAPG rates,539.1,90,,,percent of total billed charges,90% of total billed charges,539.1,90,,,percent of total billed charges,90% of total billed charges,1185.01,100,,,Fee Schedule,pays based on EAPG rates,530.71,88.6,,,percent of total billed charges,88.6% of total billed charges,1220.56,103,,,Fee Schedule,pays based on EAPG rates,191.68,32,,,percent of total billed charges,32% of total billed charges,479.2,80,,,percent of total billed charges,80% of total billed charges,479.2,80,,,percent of total billed charges,80% of total billed charges,1185.01,100,,,Fee Schedule,pays based on EAPG rates,545.09,91,,,percent of total billed charges,91% of total billed charges,195.51,32.64,,,percent of total billed charges,32.64% of total billed charges,191.68,32,,,percent of total billed charges,32% of total billed charges,201.26,33.6,,,percent of total billed charges,33.6% of total billed charges,1220.56,103,,,Fee Schedule,pays based on EAPG rates,191.68,32,,,percent of total billed charges,32% of total billed charges,191.68,32,,,percent of total billed charges,32% of total billed charges,551.08,92,,,percent of total billed charges,92% of total billed charges,191.68,1244.26,
TUBE THORACOSTOMY INCLUDE WATER SEAL,1000167,CDM,450,RC,32551,HCPCS,Outpatient,,,454,385.9,,368.65,81.2,,,percent of total billed charges,81.2% of total billed charges,148.19,32.64,,,percent of total billed charges,32.64% of total billed charges,335.96,74,,,percent of total billed charges,74% of total billed charges,335.96,74,,,percent of total billed charges,74% of total billed charges,145.28,32,,,percent of total billed charges,32% of total billed charges,482.58,103,,,Fee Schedule,pays based on EAPG rates,145.28,32,,,percent of total billed charges,32% of total billed charges,322.34,71,,,percent of total billed charges,71% of total billed charges,322.34,71,,,percent of total billed charges,71% of total billed charges,304.18,67,,,percent of total billed charges,67% of total billed charges,304.18,67,,,percent of total billed charges,67% of total billed charges,322.34,71,,,percent of total billed charges,71% of total billed charges,345.04,76,,,percent of total billed charges,76% of total billed charges,482.58,103,,,Fee Schedule,pays based on EAPG rates,149.64,32.96,,,percent of total billed charges,32.96% of total billed charges,491.95,105,,,Fee Schedule,pays based on EAPG rates,408.6,90,,,percent of total billed charges,90% of total billed charges,408.6,90,,,percent of total billed charges,90% of total billed charges,468.52,100,,,Fee Schedule,pays based on EAPG rates,402.24,88.6,,,percent of total billed charges,88.6% of total billed charges,482.58,103,,,Fee Schedule,pays based on EAPG rates,145.28,32,,,percent of total billed charges,32% of total billed charges,363.2,80,,,percent of total billed charges,80% of total billed charges,363.2,80,,,percent of total billed charges,80% of total billed charges,468.52,100,,,Fee Schedule,pays based on EAPG rates,413.14,91,,,percent of total billed charges,91% of total billed charges,148.19,32.64,,,percent of total billed charges,32.64% of total billed charges,145.28,32,,,percent of total billed charges,32% of total billed charges,152.54,33.6,,,percent of total billed charges,33.6% of total billed charges,482.58,103,,,Fee Schedule,pays based on EAPG rates,145.28,32,,,percent of total billed charges,32% of total billed charges,145.28,32,,,percent of total billed charges,32% of total billed charges,417.68,92,,,percent of total billed charges,92% of total billed charges,145.28,491.95,
"REPAIR BLODD VESSEL, DIRECT; LOWER EXT",1000232,CDM,450,RC,35226,HCPCS,Outpatient,,,131,111.35,,106.37,81.2,,,percent of total billed charges,81.2% of total billed charges,42.76,32.64,,,percent of total billed charges,32.64% of total billed charges,96.94,74,,,percent of total billed charges,74% of total billed charges,96.94,74,,,percent of total billed charges,74% of total billed charges,41.92,32,,,percent of total billed charges,32% of total billed charges,789.68,103,,,Fee Schedule,pays based on EAPG rates,41.92,32,,,percent of total billed charges,32% of total billed charges,93.01,71,,,percent of total billed charges,71% of total billed charges,93.01,71,,,percent of total billed charges,71% of total billed charges,87.77,67,,,percent of total billed charges,67% of total billed charges,87.77,67,,,percent of total billed charges,67% of total billed charges,93.01,71,,,percent of total billed charges,71% of total billed charges,99.56,76,,,percent of total billed charges,76% of total billed charges,789.68,103,,,Fee Schedule,pays based on EAPG rates,43.18,32.96,,,percent of total billed charges,32.96% of total billed charges,805.02,105,,,Fee Schedule,pays based on EAPG rates,117.9,90,,,percent of total billed charges,90% of total billed charges,117.9,90,,,percent of total billed charges,90% of total billed charges,766.68,100,,,Fee Schedule,pays based on EAPG rates,116.07,88.6,,,percent of total billed charges,88.6% of total billed charges,789.68,103,,,Fee Schedule,pays based on EAPG rates,41.92,32,,,percent of total billed charges,32% of total billed charges,104.8,80,,,percent of total billed charges,80% of total billed charges,104.8,80,,,percent of total billed charges,80% of total billed charges,766.68,100,,,Fee Schedule,pays based on EAPG rates,119.21,91,,,percent of total billed charges,91% of total billed charges,42.76,32.64,,,percent of total billed charges,32.64% of total billed charges,41.92,32,,,percent of total billed charges,32% of total billed charges,44.02,33.6,,,percent of total billed charges,33.6% of total billed charges,789.68,103,,,Fee Schedule,pays based on EAPG rates,41.92,32,,,percent of total billed charges,32% of total billed charges,41.92,32,,,percent of total billed charges,32% of total billed charges,120.52,92,,,percent of total billed charges,92% of total billed charges,41.92,805.02,
BLOOD ADMIN 1 UNIT,1000024,CDM,391,RC,36430,HCPCS,Outpatient,,,146,124.1,,118.55,81.2,,,percent of total billed charges,81.2% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,110.96,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,48.12,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,129.36,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,132.86,91,,,percent of total billed charges,91% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,49.06,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,134.32,92,,,percent of total billed charges,92% of total billed charges,46.72,293.63,
BLOOD ADMIN 2 UNITS,1000025,CDM,391,RC,36430,HCPCS,Outpatient,,,220,187,,178.64,81.2,,,percent of total billed charges,81.2% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,167.2,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,72.51,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,194.92,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,200.2,91,,,percent of total billed charges,91% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,73.92,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,202.4,92,,,percent of total billed charges,92% of total billed charges,70.4,293.63,
BLOOD ADMIN 3 UNITS,1000026,CDM,391,RC,36430,HCPCS,Outpatient,,,310,263.5,,251.72,81.2,,,percent of total billed charges,81.2% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,235.6,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,102.18,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,274.66,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,282.1,91,,,percent of total billed charges,91% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,104.16,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,285.2,92,,,percent of total billed charges,92% of total billed charges,99.2,293.63,
BLOOD ADMIN 4 UNITS,1000027,CDM,391,RC,36430,HCPCS,Outpatient,,,387,328.95,,314.24,81.2,,,percent of total billed charges,81.2% of total billed charges,126.32,32.64,,,percent of total billed charges,32.64% of total billed charges,286.38,74,,,percent of total billed charges,74% of total billed charges,286.38,74,,,percent of total billed charges,74% of total billed charges,123.84,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,123.84,32,,,percent of total billed charges,32% of total billed charges,274.77,71,,,percent of total billed charges,71% of total billed charges,274.77,71,,,percent of total billed charges,71% of total billed charges,259.29,67,,,percent of total billed charges,67% of total billed charges,259.29,67,,,percent of total billed charges,67% of total billed charges,274.77,71,,,percent of total billed charges,71% of total billed charges,294.12,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,127.56,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,348.3,90,,,percent of total billed charges,90% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,342.88,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,123.84,32,,,percent of total billed charges,32% of total billed charges,309.6,80,,,percent of total billed charges,80% of total billed charges,309.6,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,352.17,91,,,percent of total billed charges,91% of total billed charges,126.32,32.64,,,percent of total billed charges,32.64% of total billed charges,123.84,32,,,percent of total billed charges,32% of total billed charges,130.03,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,123.84,32,,,percent of total billed charges,32% of total billed charges,123.84,32,,,percent of total billed charges,32% of total billed charges,356.04,92,,,percent of total billed charges,92% of total billed charges,123.84,356.04,
BLOOD ADMIN 5 UNITS,1000028,CDM,391,RC,36430,HCPCS,Outpatient,,,461,391.85,,374.33,81.2,,,percent of total billed charges,81.2% of total billed charges,150.47,32.64,,,percent of total billed charges,32.64% of total billed charges,341.14,74,,,percent of total billed charges,74% of total billed charges,341.14,74,,,percent of total billed charges,74% of total billed charges,147.52,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,147.52,32,,,percent of total billed charges,32% of total billed charges,327.31,71,,,percent of total billed charges,71% of total billed charges,327.31,71,,,percent of total billed charges,71% of total billed charges,308.87,67,,,percent of total billed charges,67% of total billed charges,308.87,67,,,percent of total billed charges,67% of total billed charges,327.31,71,,,percent of total billed charges,71% of total billed charges,350.36,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,151.95,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,408.45,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,147.52,32,,,percent of total billed charges,32% of total billed charges,368.8,80,,,percent of total billed charges,80% of total billed charges,368.8,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,419.51,91,,,percent of total billed charges,91% of total billed charges,150.47,32.64,,,percent of total billed charges,32.64% of total billed charges,147.52,32,,,percent of total billed charges,32% of total billed charges,154.9,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,147.52,32,,,percent of total billed charges,32% of total billed charges,147.52,32,,,percent of total billed charges,32% of total billed charges,424.12,92,,,percent of total billed charges,92% of total billed charges,147.52,424.12,
BLOOD ADMIN 6+ UNITS,1000029,CDM,391,RC,36430,HCPCS,Outpatient,,,543,461.55,,440.92,81.2,,,percent of total billed charges,81.2% of total billed charges,177.24,32.64,,,percent of total billed charges,32.64% of total billed charges,401.82,74,,,percent of total billed charges,74% of total billed charges,401.82,74,,,percent of total billed charges,74% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,363.81,67,,,percent of total billed charges,67% of total billed charges,363.81,67,,,percent of total billed charges,67% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,412.68,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,178.97,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,488.7,90,,,percent of total billed charges,90% of total billed charges,488.7,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,481.1,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,434.4,80,,,percent of total billed charges,80% of total billed charges,434.4,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,494.13,91,,,percent of total billed charges,91% of total billed charges,177.24,32.64,,,percent of total billed charges,32.64% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,182.45,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,499.56,92,,,percent of total billed charges,92% of total billed charges,173.76,499.56,
INSERTION NTCICVC >5 YRS,1000168,CDM,450,RC,36556,HCPCS,Outpatient,,,429,364.65,,348.35,81.2,,,percent of total billed charges,81.2% of total billed charges,140.03,32.64,,,percent of total billed charges,32.64% of total billed charges,317.46,74,,,percent of total billed charges,74% of total billed charges,317.46,74,,,percent of total billed charges,74% of total billed charges,137.28,32,,,percent of total billed charges,32% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,137.28,32,,,percent of total billed charges,32% of total billed charges,304.59,71,,,percent of total billed charges,71% of total billed charges,304.59,71,,,percent of total billed charges,71% of total billed charges,287.43,67,,,percent of total billed charges,67% of total billed charges,287.43,67,,,percent of total billed charges,67% of total billed charges,304.59,71,,,percent of total billed charges,71% of total billed charges,326.04,76,,,percent of total billed charges,76% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,141.4,32.96,,,percent of total billed charges,32.96% of total billed charges,497.73,105,,,Fee Schedule,pays based on EAPG rates,386.1,90,,,percent of total billed charges,90% of total billed charges,386.1,90,,,percent of total billed charges,90% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,380.09,88.6,,,percent of total billed charges,88.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,137.28,32,,,percent of total billed charges,32% of total billed charges,343.2,80,,,percent of total billed charges,80% of total billed charges,343.2,80,,,percent of total billed charges,80% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,390.39,91,,,percent of total billed charges,91% of total billed charges,140.03,32.64,,,percent of total billed charges,32.64% of total billed charges,137.28,32,,,percent of total billed charges,32% of total billed charges,144.14,33.6,,,percent of total billed charges,33.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,137.28,32,,,percent of total billed charges,32% of total billed charges,137.28,32,,,percent of total billed charges,32% of total billed charges,394.68,92,,,percent of total billed charges,92% of total billed charges,137.28,497.73,
INSERT TCICVC WO PRT/PMP >5 YRS,1000169,CDM,450,RC,36558,HCPCS,Outpatient,,,1018,865.3,,826.62,81.2,,,percent of total billed charges,81.2% of total billed charges,332.28,32.64,,,percent of total billed charges,32.64% of total billed charges,753.32,74,,,percent of total billed charges,74% of total billed charges,753.32,74,,,percent of total billed charges,74% of total billed charges,325.76,32,,,percent of total billed charges,32% of total billed charges,1030.71,103,,,Fee Schedule,pays based on EAPG rates,325.76,32,,,percent of total billed charges,32% of total billed charges,722.78,71,,,percent of total billed charges,71% of total billed charges,722.78,71,,,percent of total billed charges,71% of total billed charges,682.06,67,,,percent of total billed charges,67% of total billed charges,682.06,67,,,percent of total billed charges,67% of total billed charges,722.78,71,,,percent of total billed charges,71% of total billed charges,773.68,76,,,percent of total billed charges,76% of total billed charges,1030.71,103,,,Fee Schedule,pays based on EAPG rates,335.53,32.96,,,percent of total billed charges,32.96% of total billed charges,1050.73,105,,,Fee Schedule,pays based on EAPG rates,916.2,90,,,percent of total billed charges,90% of total billed charges,916.2,90,,,percent of total billed charges,90% of total billed charges,1000.69,100,,,Fee Schedule,pays based on EAPG rates,901.95,88.6,,,percent of total billed charges,88.6% of total billed charges,1030.71,103,,,Fee Schedule,pays based on EAPG rates,325.76,32,,,percent of total billed charges,32% of total billed charges,814.4,80,,,percent of total billed charges,80% of total billed charges,814.4,80,,,percent of total billed charges,80% of total billed charges,1000.69,100,,,Fee Schedule,pays based on EAPG rates,926.38,91,,,percent of total billed charges,91% of total billed charges,332.28,32.64,,,percent of total billed charges,32.64% of total billed charges,325.76,32,,,percent of total billed charges,32% of total billed charges,342.05,33.6,,,percent of total billed charges,33.6% of total billed charges,1030.71,103,,,Fee Schedule,pays based on EAPG rates,325.76,32,,,percent of total billed charges,32% of total billed charges,325.76,32,,,percent of total billed charges,32% of total billed charges,936.56,92,,,percent of total billed charges,92% of total billed charges,325.76,1050.73,
NSRT PICC WO SBCTNS PT/PMP >5 YRS,1000170,CDM,450,RC,36569,HCPCS,Outpatient,,,351,298.35,,285.01,81.2,,,percent of total billed charges,81.2% of total billed charges,114.57,32.64,,,percent of total billed charges,32.64% of total billed charges,259.74,74,,,percent of total billed charges,74% of total billed charges,259.74,74,,,percent of total billed charges,74% of total billed charges,112.32,32,,,percent of total billed charges,32% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,112.32,32,,,percent of total billed charges,32% of total billed charges,249.21,71,,,percent of total billed charges,71% of total billed charges,249.21,71,,,percent of total billed charges,71% of total billed charges,235.17,67,,,percent of total billed charges,67% of total billed charges,235.17,67,,,percent of total billed charges,67% of total billed charges,249.21,71,,,percent of total billed charges,71% of total billed charges,266.76,76,,,percent of total billed charges,76% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,115.69,32.96,,,percent of total billed charges,32.96% of total billed charges,497.73,105,,,Fee Schedule,pays based on EAPG rates,315.9,90,,,percent of total billed charges,90% of total billed charges,315.9,90,,,percent of total billed charges,90% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,310.99,88.6,,,percent of total billed charges,88.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,112.32,32,,,percent of total billed charges,32% of total billed charges,280.8,80,,,percent of total billed charges,80% of total billed charges,280.8,80,,,percent of total billed charges,80% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,319.41,91,,,percent of total billed charges,91% of total billed charges,114.57,32.64,,,percent of total billed charges,32.64% of total billed charges,112.32,32,,,percent of total billed charges,32% of total billed charges,117.94,33.6,,,percent of total billed charges,33.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,112.32,32,,,percent of total billed charges,32% of total billed charges,112.32,32,,,percent of total billed charges,32% of total billed charges,322.92,92,,,percent of total billed charges,92% of total billed charges,112.32,497.73,
INSERTION OF PICC ACCESS DEVICE WITH,1000171,CDM,450,RC,36571,HCPCS,Outpatient,,,1094,929.9,,888.33,81.2,,,percent of total billed charges,81.2% of total billed charges,357.08,32.64,,,percent of total billed charges,32.64% of total billed charges,809.56,74,,,percent of total billed charges,74% of total billed charges,809.56,74,,,percent of total billed charges,74% of total billed charges,350.08,32,,,percent of total billed charges,32% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,350.08,32,,,percent of total billed charges,32% of total billed charges,776.74,71,,,percent of total billed charges,71% of total billed charges,776.74,71,,,percent of total billed charges,71% of total billed charges,732.98,67,,,percent of total billed charges,67% of total billed charges,732.98,67,,,percent of total billed charges,67% of total billed charges,776.74,71,,,percent of total billed charges,71% of total billed charges,831.44,76,,,percent of total billed charges,76% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,360.58,32.96,,,percent of total billed charges,32.96% of total billed charges,497.73,105,,,Fee Schedule,pays based on EAPG rates,984.6,90,,,percent of total billed charges,90% of total billed charges,984.6,90,,,percent of total billed charges,90% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,969.28,88.6,,,percent of total billed charges,88.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,350.08,32,,,percent of total billed charges,32% of total billed charges,875.2,80,,,percent of total billed charges,80% of total billed charges,875.2,80,,,percent of total billed charges,80% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,995.54,91,,,percent of total billed charges,91% of total billed charges,357.08,32.64,,,percent of total billed charges,32.64% of total billed charges,350.08,32,,,percent of total billed charges,32% of total billed charges,367.58,33.6,,,percent of total billed charges,33.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,350.08,32,,,percent of total billed charges,32% of total billed charges,350.08,32,,,percent of total billed charges,32% of total billed charges,1006.48,92,,,percent of total billed charges,92% of total billed charges,350.08,1006.48,
INSERT PICC W/ IMAGE GUIDE >5 YRS,1000415,CDM,450,RC,36573,HCPCS,Outpatient,,,3049,2591.65,,2475.79,81.2,,,percent of total billed charges,81.2% of total billed charges,995.19,32.64,,,percent of total billed charges,32.64% of total billed charges,2256.26,74,,,percent of total billed charges,74% of total billed charges,2256.26,74,,,percent of total billed charges,74% of total billed charges,975.68,32,,,percent of total billed charges,32% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,975.68,32,,,percent of total billed charges,32% of total billed charges,2164.79,71,,,percent of total billed charges,71% of total billed charges,2164.79,71,,,percent of total billed charges,71% of total billed charges,2042.83,67,,,percent of total billed charges,67% of total billed charges,2042.83,67,,,percent of total billed charges,67% of total billed charges,2164.79,71,,,percent of total billed charges,71% of total billed charges,2317.24,76,,,percent of total billed charges,76% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,1004.95,32.96,,,percent of total billed charges,32.96% of total billed charges,497.73,105,,,Fee Schedule,pays based on EAPG rates,2744.1,90,,,percent of total billed charges,90% of total billed charges,2744.1,90,,,percent of total billed charges,90% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,2701.41,88.6,,,percent of total billed charges,88.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,975.68,32,,,percent of total billed charges,32% of total billed charges,2439.2,80,,,percent of total billed charges,80% of total billed charges,2439.2,80,,,percent of total billed charges,80% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,2774.59,91,,,percent of total billed charges,91% of total billed charges,995.19,32.64,,,percent of total billed charges,32.64% of total billed charges,975.68,32,,,percent of total billed charges,32% of total billed charges,1024.46,33.6,,,percent of total billed charges,33.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,975.68,32,,,percent of total billed charges,32% of total billed charges,975.68,32,,,percent of total billed charges,32% of total billed charges,2805.08,92,,,percent of total billed charges,92% of total billed charges,474.03,2805.08,
RMVL TNNLD CNTRL VN ACC DVC W/SBCTNS,1000172,CDM,450,RC,36590,HCPCS,Outpatient,,,706,600.1,,573.27,81.2,,,percent of total billed charges,81.2% of total billed charges,230.44,32.64,,,percent of total billed charges,32.64% of total billed charges,522.44,74,,,percent of total billed charges,74% of total billed charges,522.44,74,,,percent of total billed charges,74% of total billed charges,225.92,32,,,percent of total billed charges,32% of total billed charges,370.46,103,,,Fee Schedule,pays based on EAPG rates,225.92,32,,,percent of total billed charges,32% of total billed charges,501.26,71,,,percent of total billed charges,71% of total billed charges,501.26,71,,,percent of total billed charges,71% of total billed charges,473.02,67,,,percent of total billed charges,67% of total billed charges,473.02,67,,,percent of total billed charges,67% of total billed charges,501.26,71,,,percent of total billed charges,71% of total billed charges,536.56,76,,,percent of total billed charges,76% of total billed charges,370.46,103,,,Fee Schedule,pays based on EAPG rates,232.7,32.96,,,percent of total billed charges,32.96% of total billed charges,377.65,105,,,Fee Schedule,pays based on EAPG rates,635.4,90,,,percent of total billed charges,90% of total billed charges,635.4,90,,,percent of total billed charges,90% of total billed charges,359.67,100,,,Fee Schedule,pays based on EAPG rates,625.52,88.6,,,percent of total billed charges,88.6% of total billed charges,370.46,103,,,Fee Schedule,pays based on EAPG rates,225.92,32,,,percent of total billed charges,32% of total billed charges,564.8,80,,,percent of total billed charges,80% of total billed charges,564.8,80,,,percent of total billed charges,80% of total billed charges,359.67,100,,,Fee Schedule,pays based on EAPG rates,642.46,91,,,percent of total billed charges,91% of total billed charges,230.44,32.64,,,percent of total billed charges,32.64% of total billed charges,225.92,32,,,percent of total billed charges,32% of total billed charges,237.22,33.6,,,percent of total billed charges,33.6% of total billed charges,370.46,103,,,Fee Schedule,pays based on EAPG rates,225.92,32,,,percent of total billed charges,32% of total billed charges,225.92,32,,,percent of total billed charges,32% of total billed charges,649.52,92,,,percent of total billed charges,92% of total billed charges,225.92,649.52,
PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INF,1000244,CDM,450,RC,36680,HCPCS,Outpatient,,,196,166.6,,159.15,81.2,,,percent of total billed charges,81.2% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,148.96,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,64.6,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,176.4,90,,,percent of total billed charges,90% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,173.66,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,178.36,91,,,percent of total billed charges,91% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,65.86,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,180.32,92,,,percent of total billed charges,92% of total billed charges,62.72,180.32,
RPR LIP FULL THICKNESS HALF/<VERTICAL HE,1000249,CDM,450,RC,40652,HCPCS,Outpatient,,,720,612,,584.64,81.2,,,percent of total billed charges,81.2% of total billed charges,235.01,32.64,,,percent of total billed charges,32.64% of total billed charges,532.8,74,,,percent of total billed charges,74% of total billed charges,532.8,74,,,percent of total billed charges,74% of total billed charges,230.4,32,,,percent of total billed charges,32% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,230.4,32,,,percent of total billed charges,32% of total billed charges,511.2,71,,,percent of total billed charges,71% of total billed charges,511.2,71,,,percent of total billed charges,71% of total billed charges,482.4,67,,,percent of total billed charges,67% of total billed charges,482.4,67,,,percent of total billed charges,67% of total billed charges,511.2,71,,,percent of total billed charges,71% of total billed charges,547.2,76,,,percent of total billed charges,76% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,237.31,32.96,,,percent of total billed charges,32.96% of total billed charges,607.78,105,,,Fee Schedule,pays based on EAPG rates,648,90,,,percent of total billed charges,90% of total billed charges,648,90,,,percent of total billed charges,90% of total billed charges,578.84,100,,,Fee Schedule,pays based on EAPG rates,637.92,88.6,,,percent of total billed charges,88.6% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,230.4,32,,,percent of total billed charges,32% of total billed charges,576,80,,,percent of total billed charges,80% of total billed charges,576,80,,,percent of total billed charges,80% of total billed charges,578.84,100,,,Fee Schedule,pays based on EAPG rates,655.2,91,,,percent of total billed charges,91% of total billed charges,235.01,32.64,,,percent of total billed charges,32.64% of total billed charges,230.4,32,,,percent of total billed charges,32% of total billed charges,241.92,33.6,,,percent of total billed charges,33.6% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,230.4,32,,,percent of total billed charges,32% of total billed charges,230.4,32,,,percent of total billed charges,32% of total billed charges,662.4,92,,,percent of total billed charges,92% of total billed charges,230.4,662.4,
"DRAINAGE ABCS,CYST, HMTMA VST MTH SIMPLE",1000173,CDM,450,RC,40800,HCPCS,Outpatient,,,236,200.6,,191.63,81.2,,,percent of total billed charges,81.2% of total billed charges,77.03,32.64,,,percent of total billed charges,32.64% of total billed charges,174.64,74,,,percent of total billed charges,74% of total billed charges,174.64,74,,,percent of total billed charges,74% of total billed charges,75.52,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,75.52,32,,,percent of total billed charges,32% of total billed charges,167.56,71,,,percent of total billed charges,71% of total billed charges,167.56,71,,,percent of total billed charges,71% of total billed charges,158.12,67,,,percent of total billed charges,67% of total billed charges,158.12,67,,,percent of total billed charges,67% of total billed charges,167.56,71,,,percent of total billed charges,71% of total billed charges,179.36,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,77.79,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,209.1,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,75.52,32,,,percent of total billed charges,32% of total billed charges,188.8,80,,,percent of total billed charges,80% of total billed charges,188.8,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,214.76,91,,,percent of total billed charges,91% of total billed charges,77.03,32.64,,,percent of total billed charges,32.64% of total billed charges,75.52,32,,,percent of total billed charges,32% of total billed charges,79.3,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,75.52,32,,,percent of total billed charges,32% of total billed charges,75.52,32,,,percent of total billed charges,32% of total billed charges,217.12,92,,,percent of total billed charges,92% of total billed charges,66.31,217.12,
RPR LAC => 2.5CM MOUTH FLR/TONGUE,1000226,CDM,450,RC,41250,HCPCS,Outpatient,,,320,272,,259.84,81.2,,,percent of total billed charges,81.2% of total billed charges,104.45,32.64,,,percent of total billed charges,32.64% of total billed charges,236.8,74,,,percent of total billed charges,74% of total billed charges,236.8,74,,,percent of total billed charges,74% of total billed charges,102.4,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,102.4,32,,,percent of total billed charges,32% of total billed charges,227.2,71,,,percent of total billed charges,71% of total billed charges,227.2,71,,,percent of total billed charges,71% of total billed charges,214.4,67,,,percent of total billed charges,67% of total billed charges,214.4,67,,,percent of total billed charges,67% of total billed charges,227.2,71,,,percent of total billed charges,71% of total billed charges,243.2,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,105.47,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,288,90,,,percent of total billed charges,90% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,283.52,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,102.4,32,,,percent of total billed charges,32% of total billed charges,256,80,,,percent of total billed charges,80% of total billed charges,256,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,291.2,91,,,percent of total billed charges,91% of total billed charges,104.45,32.64,,,percent of total billed charges,32.64% of total billed charges,102.4,32,,,percent of total billed charges,32% of total billed charges,107.52,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,102.4,32,,,percent of total billed charges,32% of total billed charges,102.4,32,,,percent of total billed charges,32% of total billed charges,294.4,92,,,percent of total billed charges,92% of total billed charges,66.31,294.4,
RPR LAC => 2.5CM MTH FLR/ PSTR TNG,1000388,CDM,450,RC,41251,HCPCS,Outpatient,,,759,645.15,,616.31,81.2,,,percent of total billed charges,81.2% of total billed charges,247.74,32.64,,,percent of total billed charges,32.64% of total billed charges,561.66,74,,,percent of total billed charges,74% of total billed charges,561.66,74,,,percent of total billed charges,74% of total billed charges,242.88,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,242.88,32,,,percent of total billed charges,32% of total billed charges,538.89,71,,,percent of total billed charges,71% of total billed charges,538.89,71,,,percent of total billed charges,71% of total billed charges,508.53,67,,,percent of total billed charges,67% of total billed charges,508.53,67,,,percent of total billed charges,67% of total billed charges,538.89,71,,,percent of total billed charges,71% of total billed charges,576.84,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,250.17,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,683.1,90,,,percent of total billed charges,90% of total billed charges,683.1,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,672.47,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,242.88,32,,,percent of total billed charges,32% of total billed charges,607.2,80,,,percent of total billed charges,80% of total billed charges,607.2,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,690.69,91,,,percent of total billed charges,91% of total billed charges,247.74,32.64,,,percent of total billed charges,32.64% of total billed charges,242.88,32,,,percent of total billed charges,32% of total billed charges,255.02,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,242.88,32,,,percent of total billed charges,32% of total billed charges,242.88,32,,,percent of total billed charges,32% of total billed charges,698.28,92,,,percent of total billed charges,92% of total billed charges,66.31,698.28,
RPR TONGUE/MOUTH FLOOR  >2.5CM,1000424,CDM,450,RC,41252,HCPCS,Outpatient,,,954,810.9,,774.65,81.2,,,percent of total billed charges,81.2% of total billed charges,311.39,32.64,,,percent of total billed charges,32.64% of total billed charges,705.96,74,,,percent of total billed charges,74% of total billed charges,705.96,74,,,percent of total billed charges,74% of total billed charges,305.28,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,305.28,32,,,percent of total billed charges,32% of total billed charges,677.34,71,,,percent of total billed charges,71% of total billed charges,677.34,71,,,percent of total billed charges,71% of total billed charges,639.18,67,,,percent of total billed charges,67% of total billed charges,639.18,67,,,percent of total billed charges,67% of total billed charges,677.34,71,,,percent of total billed charges,71% of total billed charges,725.04,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,314.44,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,845.24,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,305.28,32,,,percent of total billed charges,32% of total billed charges,763.2,80,,,percent of total billed charges,80% of total billed charges,763.2,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,868.14,91,,,percent of total billed charges,91% of total billed charges,311.39,32.64,,,percent of total billed charges,32.64% of total billed charges,305.28,32,,,percent of total billed charges,32% of total billed charges,320.54,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,305.28,32,,,percent of total billed charges,32% of total billed charges,305.28,32,,,percent of total billed charges,32% of total billed charges,877.68,92,,,percent of total billed charges,92% of total billed charges,66.31,877.68,
DRAIN ABSCESS CYST HEMATUMA FRM DENTOAL,1000187,CDM,450,RC,41800,HCPCS,Outpatient,,,217,184.45,,176.2,81.2,,,percent of total billed charges,81.2% of total billed charges,70.83,32.64,,,percent of total billed charges,32.64% of total billed charges,160.58,74,,,percent of total billed charges,74% of total billed charges,160.58,74,,,percent of total billed charges,74% of total billed charges,69.44,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,69.44,32,,,percent of total billed charges,32% of total billed charges,154.07,71,,,percent of total billed charges,71% of total billed charges,154.07,71,,,percent of total billed charges,71% of total billed charges,145.39,67,,,percent of total billed charges,67% of total billed charges,145.39,67,,,percent of total billed charges,67% of total billed charges,154.07,71,,,percent of total billed charges,71% of total billed charges,164.92,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,71.52,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,195.3,90,,,percent of total billed charges,90% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,192.26,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,69.44,32,,,percent of total billed charges,32% of total billed charges,173.6,80,,,percent of total billed charges,80% of total billed charges,173.6,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,197.47,91,,,percent of total billed charges,91% of total billed charges,70.83,32.64,,,percent of total billed charges,32.64% of total billed charges,69.44,32,,,percent of total billed charges,32% of total billed charges,72.91,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,69.44,32,,,percent of total billed charges,32% of total billed charges,69.44,32,,,percent of total billed charges,32% of total billed charges,199.64,92,,,percent of total billed charges,92% of total billed charges,66.31,199.64,
UNLISTED PX DENTALVLR STRUX,1000488,CDM,450,RC,41899,HCPCS,Outpatient,,,649,551.65,,526.99,81.2,,,percent of total billed charges,81.2% of total billed charges,211.83,32.64,,,percent of total billed charges,32.64% of total billed charges,480.26,74,,,percent of total billed charges,74% of total billed charges,480.26,74,,,percent of total billed charges,74% of total billed charges,207.68,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,207.68,32,,,percent of total billed charges,32% of total billed charges,460.79,71,,,percent of total billed charges,71% of total billed charges,460.79,71,,,percent of total billed charges,71% of total billed charges,434.83,67,,,percent of total billed charges,67% of total billed charges,434.83,67,,,percent of total billed charges,67% of total billed charges,460.79,71,,,percent of total billed charges,71% of total billed charges,493.24,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,213.91,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,584.1,90,,,percent of total billed charges,90% of total billed charges,584.1,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,575.01,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,207.68,32,,,percent of total billed charges,32% of total billed charges,519.2,80,,,percent of total billed charges,80% of total billed charges,519.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,590.59,91,,,percent of total billed charges,91% of total billed charges,211.83,32.64,,,percent of total billed charges,32.64% of total billed charges,207.68,32,,,percent of total billed charges,32% of total billed charges,218.06,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,207.68,32,,,percent of total billed charges,32% of total billed charges,207.68,32,,,percent of total billed charges,32% of total billed charges,597.08,92,,,percent of total billed charges,92% of total billed charges,207.68,597.08,
"DRAINAGE ABSCESS PALATE, UVULA",1000266,CDM,450,RC,42000,HCPCS,Outpatient,,,188,159.8,,152.66,81.2,,,percent of total billed charges,81.2% of total billed charges,61.36,32.64,,,percent of total billed charges,32.64% of total billed charges,139.12,74,,,percent of total billed charges,74% of total billed charges,139.12,74,,,percent of total billed charges,74% of total billed charges,60.16,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,60.16,32,,,percent of total billed charges,32% of total billed charges,133.48,71,,,percent of total billed charges,71% of total billed charges,133.48,71,,,percent of total billed charges,71% of total billed charges,125.96,67,,,percent of total billed charges,67% of total billed charges,125.96,67,,,percent of total billed charges,67% of total billed charges,133.48,71,,,percent of total billed charges,71% of total billed charges,142.88,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,61.96,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,169.2,90,,,percent of total billed charges,90% of total billed charges,169.2,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,166.57,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,60.16,32,,,percent of total billed charges,32% of total billed charges,150.4,80,,,percent of total billed charges,80% of total billed charges,150.4,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,171.08,91,,,percent of total billed charges,91% of total billed charges,61.36,32.64,,,percent of total billed charges,32.64% of total billed charges,60.16,32,,,percent of total billed charges,32% of total billed charges,63.17,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,60.16,32,,,percent of total billed charges,32% of total billed charges,60.16,32,,,percent of total billed charges,32% of total billed charges,172.96,92,,,percent of total billed charges,92% of total billed charges,60.16,172.96,
INCISION AND DRAIN ABSCESS; PERITONSILLA,1000437,CDM,450,RC,42700,HCPCS,Outpatient,,,722,613.7,,586.26,81.2,,,percent of total billed charges,81.2% of total billed charges,235.66,32.64,,,percent of total billed charges,32.64% of total billed charges,534.28,74,,,percent of total billed charges,74% of total billed charges,534.28,74,,,percent of total billed charges,74% of total billed charges,231.04,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,231.04,32,,,percent of total billed charges,32% of total billed charges,512.62,71,,,percent of total billed charges,71% of total billed charges,512.62,71,,,percent of total billed charges,71% of total billed charges,483.74,67,,,percent of total billed charges,67% of total billed charges,483.74,67,,,percent of total billed charges,67% of total billed charges,512.62,71,,,percent of total billed charges,71% of total billed charges,548.72,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,237.97,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,649.8,90,,,percent of total billed charges,90% of total billed charges,649.8,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,639.69,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,231.04,32,,,percent of total billed charges,32% of total billed charges,577.6,80,,,percent of total billed charges,80% of total billed charges,577.6,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,657.02,91,,,percent of total billed charges,91% of total billed charges,235.66,32.64,,,percent of total billed charges,32.64% of total billed charges,231.04,32,,,percent of total billed charges,32% of total billed charges,242.59,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,231.04,32,,,percent of total billed charges,32% of total billed charges,231.04,32,,,percent of total billed charges,32% of total billed charges,664.24,92,,,percent of total billed charges,92% of total billed charges,66.31,664.24,
GASTRIC INTUBAT & ASPIRA W/PHYS SKILL/LA,1000253,CDM,450,RC,43753,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,193.67,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,184.45,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,184.45,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,189.98,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,24,193.67,
CHANGE OF GASTROSTOMY TUBE PERCUTANEOUS,1000205,CDM,450,RC,43762,HCPCS,Outpatient,,,152,129.2,,123.42,81.2,,,percent of total billed charges,81.2% of total billed charges,49.61,32.64,,,percent of total billed charges,32.64% of total billed charges,112.48,74,,,percent of total billed charges,74% of total billed charges,112.48,74,,,percent of total billed charges,74% of total billed charges,48.64,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,48.64,32,,,percent of total billed charges,32% of total billed charges,107.92,71,,,percent of total billed charges,71% of total billed charges,107.92,71,,,percent of total billed charges,71% of total billed charges,101.84,67,,,percent of total billed charges,67% of total billed charges,101.84,67,,,percent of total billed charges,67% of total billed charges,107.92,71,,,percent of total billed charges,71% of total billed charges,115.52,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,50.1,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,136.8,90,,,percent of total billed charges,90% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,134.67,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,48.64,32,,,percent of total billed charges,32% of total billed charges,121.6,80,,,percent of total billed charges,80% of total billed charges,121.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,138.32,91,,,percent of total billed charges,91% of total billed charges,49.61,32.64,,,percent of total billed charges,32.64% of total billed charges,48.64,32,,,percent of total billed charges,32% of total billed charges,51.07,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,48.64,32,,,percent of total billed charges,32% of total billed charges,48.64,32,,,percent of total billed charges,32% of total billed charges,139.84,92,,,percent of total billed charges,92% of total billed charges,48.64,139.84,
REMOVAL OF FECAL IMPACTION/FOREIGN BODY,1000256,CDM,450,RC,45915,HCPCS,Outpatient,,,518,440.3,,420.62,81.2,,,percent of total billed charges,81.2% of total billed charges,169.08,32.64,,,percent of total billed charges,32.64% of total billed charges,383.32,74,,,percent of total billed charges,74% of total billed charges,383.32,74,,,percent of total billed charges,74% of total billed charges,165.76,32,,,percent of total billed charges,32% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,165.76,32,,,percent of total billed charges,32% of total billed charges,367.78,71,,,percent of total billed charges,71% of total billed charges,367.78,71,,,percent of total billed charges,71% of total billed charges,347.06,67,,,percent of total billed charges,67% of total billed charges,347.06,67,,,percent of total billed charges,67% of total billed charges,367.78,71,,,percent of total billed charges,71% of total billed charges,393.68,76,,,percent of total billed charges,76% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,170.73,32.96,,,percent of total billed charges,32.96% of total billed charges,703.39,105,,,Fee Schedule,pays based on EAPG rates,466.2,90,,,percent of total billed charges,90% of total billed charges,466.2,90,,,percent of total billed charges,90% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,458.95,88.6,,,percent of total billed charges,88.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,165.76,32,,,percent of total billed charges,32% of total billed charges,414.4,80,,,percent of total billed charges,80% of total billed charges,414.4,80,,,percent of total billed charges,80% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,471.38,91,,,percent of total billed charges,91% of total billed charges,169.08,32.64,,,percent of total billed charges,32.64% of total billed charges,165.76,32,,,percent of total billed charges,32% of total billed charges,174.05,33.6,,,percent of total billed charges,33.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,165.76,32,,,percent of total billed charges,32% of total billed charges,165.76,32,,,percent of total billed charges,32% of total billed charges,476.56,92,,,percent of total billed charges,92% of total billed charges,165.76,703.39,
INCISION & DRAINAGE OF ISCHIORECTAL/PERI,1000209,CDM,450,RC,46040,HCPCS,Outpatient,,,904,768.4,,734.05,81.2,,,percent of total billed charges,81.2% of total billed charges,295.07,32.64,,,percent of total billed charges,32.64% of total billed charges,668.96,74,,,percent of total billed charges,74% of total billed charges,668.96,74,,,percent of total billed charges,74% of total billed charges,289.28,32,,,percent of total billed charges,32% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,289.28,32,,,percent of total billed charges,32% of total billed charges,641.84,71,,,percent of total billed charges,71% of total billed charges,641.84,71,,,percent of total billed charges,71% of total billed charges,605.68,67,,,percent of total billed charges,67% of total billed charges,605.68,67,,,percent of total billed charges,67% of total billed charges,641.84,71,,,percent of total billed charges,71% of total billed charges,687.04,76,,,percent of total billed charges,76% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,297.96,32.96,,,percent of total billed charges,32.96% of total billed charges,703.39,105,,,Fee Schedule,pays based on EAPG rates,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,800.94,88.6,,,percent of total billed charges,88.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,289.28,32,,,percent of total billed charges,32% of total billed charges,723.2,80,,,percent of total billed charges,80% of total billed charges,723.2,80,,,percent of total billed charges,80% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,822.64,91,,,percent of total billed charges,91% of total billed charges,295.07,32.64,,,percent of total billed charges,32.64% of total billed charges,289.28,32,,,percent of total billed charges,32% of total billed charges,303.74,33.6,,,percent of total billed charges,33.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,289.28,32,,,percent of total billed charges,32% of total billed charges,289.28,32,,,percent of total billed charges,32% of total billed charges,831.68,92,,,percent of total billed charges,92% of total billed charges,289.28,831.68,
I & D PERIANAL ABSCESS,1000234,CDM,450,RC,46050,HCPCS,Outpatient,,,201,170.85,,163.21,81.2,,,percent of total billed charges,81.2% of total billed charges,65.61,32.64,,,percent of total billed charges,32.64% of total billed charges,148.74,74,,,percent of total billed charges,74% of total billed charges,148.74,74,,,percent of total billed charges,74% of total billed charges,64.32,32,,,percent of total billed charges,32% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,64.32,32,,,percent of total billed charges,32% of total billed charges,142.71,71,,,percent of total billed charges,71% of total billed charges,142.71,71,,,percent of total billed charges,71% of total billed charges,134.67,67,,,percent of total billed charges,67% of total billed charges,134.67,67,,,percent of total billed charges,67% of total billed charges,142.71,71,,,percent of total billed charges,71% of total billed charges,152.76,76,,,percent of total billed charges,76% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,66.25,32.96,,,percent of total billed charges,32.96% of total billed charges,703.39,105,,,Fee Schedule,pays based on EAPG rates,180.9,90,,,percent of total billed charges,90% of total billed charges,180.9,90,,,percent of total billed charges,90% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,178.09,88.6,,,percent of total billed charges,88.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,64.32,32,,,percent of total billed charges,32% of total billed charges,160.8,80,,,percent of total billed charges,80% of total billed charges,160.8,80,,,percent of total billed charges,80% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,182.91,91,,,percent of total billed charges,91% of total billed charges,65.61,32.64,,,percent of total billed charges,32.64% of total billed charges,64.32,32,,,percent of total billed charges,32% of total billed charges,67.54,33.6,,,percent of total billed charges,33.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,64.32,32,,,percent of total billed charges,32% of total billed charges,64.32,32,,,percent of total billed charges,32% of total billed charges,184.92,92,,,percent of total billed charges,92% of total billed charges,64.32,703.39,
INCISION THROMBOSED HEMORRHOID EXTERNAL,1000174,CDM,450,RC,46083,HCPCS,Outpatient,,,237,201.45,,192.44,81.2,,,percent of total billed charges,81.2% of total billed charges,77.36,32.64,,,percent of total billed charges,32.64% of total billed charges,175.38,74,,,percent of total billed charges,74% of total billed charges,175.38,74,,,percent of total billed charges,74% of total billed charges,75.84,32,,,percent of total billed charges,32% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,75.84,32,,,percent of total billed charges,32% of total billed charges,168.27,71,,,percent of total billed charges,71% of total billed charges,168.27,71,,,percent of total billed charges,71% of total billed charges,158.79,67,,,percent of total billed charges,67% of total billed charges,158.79,67,,,percent of total billed charges,67% of total billed charges,168.27,71,,,percent of total billed charges,71% of total billed charges,180.12,76,,,percent of total billed charges,76% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,78.12,32.96,,,percent of total billed charges,32.96% of total billed charges,703.39,105,,,Fee Schedule,pays based on EAPG rates,213.3,90,,,percent of total billed charges,90% of total billed charges,213.3,90,,,percent of total billed charges,90% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,209.98,88.6,,,percent of total billed charges,88.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,75.84,32,,,percent of total billed charges,32% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,189.6,80,,,percent of total billed charges,80% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,215.67,91,,,percent of total billed charges,91% of total billed charges,77.36,32.64,,,percent of total billed charges,32.64% of total billed charges,75.84,32,,,percent of total billed charges,32% of total billed charges,79.63,33.6,,,percent of total billed charges,33.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,75.84,32,,,percent of total billed charges,32% of total billed charges,75.84,32,,,percent of total billed charges,32% of total billed charges,218.04,92,,,percent of total billed charges,92% of total billed charges,75.84,703.39,
EXCISION OF THROMBOSED HEMORRHOID EXTERN,1000250,CDM,450,RC,46320,HCPCS,Outpatient,,,268,227.8,,217.62,81.2,,,percent of total billed charges,81.2% of total billed charges,87.48,32.64,,,percent of total billed charges,32.64% of total billed charges,198.32,74,,,percent of total billed charges,74% of total billed charges,198.32,74,,,percent of total billed charges,74% of total billed charges,85.76,32,,,percent of total billed charges,32% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,85.76,32,,,percent of total billed charges,32% of total billed charges,190.28,71,,,percent of total billed charges,71% of total billed charges,190.28,71,,,percent of total billed charges,71% of total billed charges,179.56,67,,,percent of total billed charges,67% of total billed charges,179.56,67,,,percent of total billed charges,67% of total billed charges,190.28,71,,,percent of total billed charges,71% of total billed charges,203.68,76,,,percent of total billed charges,76% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,88.33,32.96,,,percent of total billed charges,32.96% of total billed charges,703.39,105,,,Fee Schedule,pays based on EAPG rates,241.2,90,,,percent of total billed charges,90% of total billed charges,241.2,90,,,percent of total billed charges,90% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,237.45,88.6,,,percent of total billed charges,88.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,85.76,32,,,percent of total billed charges,32% of total billed charges,214.4,80,,,percent of total billed charges,80% of total billed charges,214.4,80,,,percent of total billed charges,80% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,243.88,91,,,percent of total billed charges,91% of total billed charges,87.48,32.64,,,percent of total billed charges,32.64% of total billed charges,85.76,32,,,percent of total billed charges,32% of total billed charges,90.05,33.6,,,percent of total billed charges,33.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,85.76,32,,,percent of total billed charges,32% of total billed charges,85.76,32,,,percent of total billed charges,32% of total billed charges,246.56,92,,,percent of total billed charges,92% of total billed charges,85.76,703.39,
HEMORRHORDECTOMY INTERNAL BY LIGATION,1000273,CDM,450,RC,46945,HCPCS,Outpatient,,,313,266.05,,254.16,81.2,,,percent of total billed charges,81.2% of total billed charges,102.16,32.64,,,percent of total billed charges,32.64% of total billed charges,231.62,74,,,percent of total billed charges,74% of total billed charges,231.62,74,,,percent of total billed charges,74% of total billed charges,100.16,32,,,percent of total billed charges,32% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,100.16,32,,,percent of total billed charges,32% of total billed charges,222.23,71,,,percent of total billed charges,71% of total billed charges,222.23,71,,,percent of total billed charges,71% of total billed charges,209.71,67,,,percent of total billed charges,67% of total billed charges,209.71,67,,,percent of total billed charges,67% of total billed charges,222.23,71,,,percent of total billed charges,71% of total billed charges,237.88,76,,,percent of total billed charges,76% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,103.16,32.96,,,percent of total billed charges,32.96% of total billed charges,703.39,105,,,Fee Schedule,pays based on EAPG rates,281.7,90,,,percent of total billed charges,90% of total billed charges,281.7,90,,,percent of total billed charges,90% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,277.32,88.6,,,percent of total billed charges,88.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,100.16,32,,,percent of total billed charges,32% of total billed charges,250.4,80,,,percent of total billed charges,80% of total billed charges,250.4,80,,,percent of total billed charges,80% of total billed charges,669.9,100,,,Fee Schedule,pays based on EAPG rates,284.83,91,,,percent of total billed charges,91% of total billed charges,102.16,32.64,,,percent of total billed charges,32.64% of total billed charges,100.16,32,,,percent of total billed charges,32% of total billed charges,105.17,33.6,,,percent of total billed charges,33.6% of total billed charges,690,103,,,Fee Schedule,pays based on EAPG rates,100.16,32,,,percent of total billed charges,32% of total billed charges,100.16,32,,,percent of total billed charges,32% of total billed charges,287.96,92,,,percent of total billed charges,92% of total billed charges,100.16,703.39,
ABD PARACENTESIS DX/THER W/O GUIDE,1000433,CDM,450,RC,49082,HCPCS,Outpatient,,,2761,2346.85,,2241.93,81.2,,,percent of total billed charges,81.2% of total billed charges,901.19,32.64,,,percent of total billed charges,32.64% of total billed charges,2043.14,74,,,percent of total billed charges,74% of total billed charges,2043.14,74,,,percent of total billed charges,74% of total billed charges,883.52,32,,,percent of total billed charges,32% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,883.52,32,,,percent of total billed charges,32% of total billed charges,1960.31,71,,,percent of total billed charges,71% of total billed charges,1960.31,71,,,percent of total billed charges,71% of total billed charges,1849.87,67,,,percent of total billed charges,67% of total billed charges,1849.87,67,,,percent of total billed charges,67% of total billed charges,1960.31,71,,,percent of total billed charges,71% of total billed charges,2098.36,76,,,percent of total billed charges,76% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,910.03,32.96,,,percent of total billed charges,32.96% of total billed charges,298.75,105,,,Fee Schedule,pays based on EAPG rates,2484.9,90,,,percent of total billed charges,90% of total billed charges,2484.9,90,,,percent of total billed charges,90% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,2446.25,88.6,,,percent of total billed charges,88.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,883.52,32,,,percent of total billed charges,32% of total billed charges,2208.8,80,,,percent of total billed charges,80% of total billed charges,2208.8,80,,,percent of total billed charges,80% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,2512.51,91,,,percent of total billed charges,91% of total billed charges,901.19,32.64,,,percent of total billed charges,32.64% of total billed charges,883.52,32,,,percent of total billed charges,32% of total billed charges,927.7,33.6,,,percent of total billed charges,33.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,883.52,32,,,percent of total billed charges,32% of total billed charges,883.52,32,,,percent of total billed charges,32% of total billed charges,2540.12,92,,,percent of total billed charges,92% of total billed charges,284.53,2540.12,
ABDOMINAL PARACENTESIS W/ GUIDE,1000484,CDM,450,RC,49083,HCPCS,Outpatient,,,2684,2281.4,,2179.41,81.2,,,percent of total billed charges,81.2% of total billed charges,876.06,32.64,,,percent of total billed charges,32.64% of total billed charges,1986.16,74,,,percent of total billed charges,74% of total billed charges,1986.16,74,,,percent of total billed charges,74% of total billed charges,858.88,32,,,percent of total billed charges,32% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,858.88,32,,,percent of total billed charges,32% of total billed charges,1905.64,71,,,percent of total billed charges,71% of total billed charges,1905.64,71,,,percent of total billed charges,71% of total billed charges,1798.28,67,,,percent of total billed charges,67% of total billed charges,1798.28,67,,,percent of total billed charges,67% of total billed charges,1905.64,71,,,percent of total billed charges,71% of total billed charges,2039.84,76,,,percent of total billed charges,76% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,884.65,32.96,,,percent of total billed charges,32.96% of total billed charges,298.75,105,,,Fee Schedule,pays based on EAPG rates,2415.6,90,,,percent of total billed charges,90% of total billed charges,2415.6,90,,,percent of total billed charges,90% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,2378.02,88.6,,,percent of total billed charges,88.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,858.88,32,,,percent of total billed charges,32% of total billed charges,2147.2,80,,,percent of total billed charges,80% of total billed charges,2147.2,80,,,percent of total billed charges,80% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,2442.44,91,,,percent of total billed charges,91% of total billed charges,876.06,32.64,,,percent of total billed charges,32.64% of total billed charges,858.88,32,,,percent of total billed charges,32% of total billed charges,901.82,33.6,,,percent of total billed charges,33.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,858.88,32,,,percent of total billed charges,32% of total billed charges,858.88,32,,,percent of total billed charges,32% of total billed charges,2469.28,92,,,percent of total billed charges,92% of total billed charges,284.53,2469.28,
"BLADDER IRRIGATION, SIMPLE, LAVAGE C/OR",1000197,CDM,450,RC,51700,HCPCS,Outpatient,,,150,127.5,,121.8,81.2,,,percent of total billed charges,81.2% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,114,76,,,percent of total billed charges,76% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,49.44,32.96,,,percent of total billed charges,32.96% of total billed charges,32.13,105,,,Fee Schedule,pays based on EAPG rates,135,90,,,percent of total billed charges,90% of total billed charges,135,90,,,percent of total billed charges,90% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,132.9,88.6,,,percent of total billed charges,88.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,136.5,91,,,percent of total billed charges,91% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,50.4,33.6,,,percent of total billed charges,33.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,138,92,,,percent of total billed charges,92% of total billed charges,30.6,138,
CATH INSERT NON-INDWELL BLADDER,1000196,CDM,450,RC,51701,HCPCS,Outpatient,,,83,70.55,,67.4,81.2,,,percent of total billed charges,81.2% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,63.08,76,,,percent of total billed charges,76% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,27.36,32.96,,,percent of total billed charges,32.96% of total billed charges,32.13,105,,,Fee Schedule,pays based on EAPG rates,74.7,90,,,percent of total billed charges,90% of total billed charges,74.7,90,,,percent of total billed charges,90% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,73.54,88.6,,,percent of total billed charges,88.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,75.53,91,,,percent of total billed charges,91% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,27.89,33.6,,,percent of total billed charges,33.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,76.36,92,,,percent of total billed charges,92% of total billed charges,26.56,76.36,
CATH INSERT TEMP INDWELL (FOLEY),1000194,CDM,450,RC,51702,HCPCS,Outpatient,,,83,70.55,,67.4,81.2,,,percent of total billed charges,81.2% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,63.08,76,,,percent of total billed charges,76% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,27.36,32.96,,,percent of total billed charges,32.96% of total billed charges,32.13,105,,,Fee Schedule,pays based on EAPG rates,74.7,90,,,percent of total billed charges,90% of total billed charges,74.7,90,,,percent of total billed charges,90% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,73.54,88.6,,,percent of total billed charges,88.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,75.53,91,,,percent of total billed charges,91% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,27.89,33.6,,,percent of total billed charges,33.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,76.36,92,,,percent of total billed charges,92% of total billed charges,26.56,76.36,
CHANGE OF CYSTOSTOMY TUBE; SIMPLE,1000260,CDM,450,RC,51705,HCPCS,Outpatient,,,417,354.45,,338.6,81.2,,,percent of total billed charges,81.2% of total billed charges,136.11,32.64,,,percent of total billed charges,32.64% of total billed charges,308.58,74,,,percent of total billed charges,74% of total billed charges,308.58,74,,,percent of total billed charges,74% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,133.44,32,,,percent of total billed charges,32% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,279.39,67,,,percent of total billed charges,67% of total billed charges,279.39,67,,,percent of total billed charges,67% of total billed charges,296.07,71,,,percent of total billed charges,71% of total billed charges,316.92,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,137.44,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,375.3,90,,,percent of total billed charges,90% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,369.46,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,133.44,32,,,percent of total billed charges,32% of total billed charges,333.6,80,,,percent of total billed charges,80% of total billed charges,333.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,379.47,91,,,percent of total billed charges,91% of total billed charges,136.11,32.64,,,percent of total billed charges,32.64% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,140.11,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,133.44,32,,,percent of total billed charges,32% of total billed charges,133.44,32,,,percent of total billed charges,32% of total billed charges,383.64,92,,,percent of total billed charges,92% of total billed charges,133.44,383.64,
IRR CORPORA CAVERNOSA PRIAPISM,1000445,CDM,450,RC,54220,HCPCS,Outpatient,,,908,771.8,,737.3,81.2,,,percent of total billed charges,81.2% of total billed charges,296.37,32.64,,,percent of total billed charges,32.64% of total billed charges,671.92,74,,,percent of total billed charges,74% of total billed charges,671.92,74,,,percent of total billed charges,74% of total billed charges,290.56,32,,,percent of total billed charges,32% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,290.56,32,,,percent of total billed charges,32% of total billed charges,644.68,71,,,percent of total billed charges,71% of total billed charges,644.68,71,,,percent of total billed charges,71% of total billed charges,608.36,67,,,percent of total billed charges,67% of total billed charges,608.36,67,,,percent of total billed charges,67% of total billed charges,644.68,71,,,percent of total billed charges,71% of total billed charges,690.08,76,,,percent of total billed charges,76% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,299.28,32.96,,,percent of total billed charges,32.96% of total billed charges,32.13,105,,,Fee Schedule,pays based on EAPG rates,817.2,90,,,percent of total billed charges,90% of total billed charges,817.2,90,,,percent of total billed charges,90% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,804.49,88.6,,,percent of total billed charges,88.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,290.56,32,,,percent of total billed charges,32% of total billed charges,726.4,80,,,percent of total billed charges,80% of total billed charges,726.4,80,,,percent of total billed charges,80% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,826.28,91,,,percent of total billed charges,91% of total billed charges,296.37,32.64,,,percent of total billed charges,32.64% of total billed charges,290.56,32,,,percent of total billed charges,32% of total billed charges,305.09,33.6,,,percent of total billed charges,33.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,290.56,32,,,percent of total billed charges,32% of total billed charges,290.56,32,,,percent of total billed charges,32% of total billed charges,835.36,92,,,percent of total billed charges,92% of total billed charges,30.6,835.36,
I & D EPIDID/TSTIS,1000268,CDM,450,RC,54700,HCPCS,Outpatient,,,316,268.6,,256.59,81.2,,,percent of total billed charges,81.2% of total billed charges,103.14,32.64,,,percent of total billed charges,32.64% of total billed charges,233.84,74,,,percent of total billed charges,74% of total billed charges,233.84,74,,,percent of total billed charges,74% of total billed charges,101.12,32,,,percent of total billed charges,32% of total billed charges,948.45,103,,,Fee Schedule,pays based on EAPG rates,101.12,32,,,percent of total billed charges,32% of total billed charges,224.36,71,,,percent of total billed charges,71% of total billed charges,224.36,71,,,percent of total billed charges,71% of total billed charges,211.72,67,,,percent of total billed charges,67% of total billed charges,211.72,67,,,percent of total billed charges,67% of total billed charges,224.36,71,,,percent of total billed charges,71% of total billed charges,240.16,76,,,percent of total billed charges,76% of total billed charges,948.45,103,,,Fee Schedule,pays based on EAPG rates,104.15,32.96,,,percent of total billed charges,32.96% of total billed charges,966.86,105,,,Fee Schedule,pays based on EAPG rates,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,920.82,100,,,Fee Schedule,pays based on EAPG rates,279.98,88.6,,,percent of total billed charges,88.6% of total billed charges,948.45,103,,,Fee Schedule,pays based on EAPG rates,101.12,32,,,percent of total billed charges,32% of total billed charges,252.8,80,,,percent of total billed charges,80% of total billed charges,252.8,80,,,percent of total billed charges,80% of total billed charges,920.82,100,,,Fee Schedule,pays based on EAPG rates,287.56,91,,,percent of total billed charges,91% of total billed charges,103.14,32.64,,,percent of total billed charges,32.64% of total billed charges,101.12,32,,,percent of total billed charges,32% of total billed charges,106.18,33.6,,,percent of total billed charges,33.6% of total billed charges,948.45,103,,,Fee Schedule,pays based on EAPG rates,101.12,32,,,percent of total billed charges,32% of total billed charges,101.12,32,,,percent of total billed charges,32% of total billed charges,290.72,92,,,percent of total billed charges,92% of total billed charges,101.12,966.86,
INCISION & DRAINAGE OF VULVA PERINEAL AB,1000175,CDM,450,RC,56405,HCPCS,Outpatient,,,273,232.05,,221.68,81.2,,,percent of total billed charges,81.2% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,43.52,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,207.48,76,,,percent of total billed charges,76% of total billed charges,43.52,103,,,Fee Schedule,pays based on EAPG rates,89.98,32.96,,,percent of total billed charges,32.96% of total billed charges,44.37,105,,,Fee Schedule,pays based on EAPG rates,245.7,90,,,percent of total billed charges,90% of total billed charges,245.7,90,,,percent of total billed charges,90% of total billed charges,42.26,100,,,Fee Schedule,pays based on EAPG rates,241.88,88.6,,,percent of total billed charges,88.6% of total billed charges,43.52,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,42.26,100,,,Fee Schedule,pays based on EAPG rates,248.43,91,,,percent of total billed charges,91% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,91.73,33.6,,,percent of total billed charges,33.6% of total billed charges,43.52,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,251.16,92,,,percent of total billed charges,92% of total billed charges,42.26,251.16,
INCISION & DRAINAGE OF BARTHOLIN GLAND,1000259,CDM,450,RC,56420,HCPCS,Outpatient,,,225,191.25,,182.7,81.2,,,percent of total billed charges,81.2% of total billed charges,73.44,32.64,,,percent of total billed charges,32.64% of total billed charges,166.5,74,,,percent of total billed charges,74% of total billed charges,166.5,74,,,percent of total billed charges,74% of total billed charges,72,32,,,percent of total billed charges,32% of total billed charges,43.52,103,,,Fee Schedule,pays based on EAPG rates,72,32,,,percent of total billed charges,32% of total billed charges,159.75,71,,,percent of total billed charges,71% of total billed charges,159.75,71,,,percent of total billed charges,71% of total billed charges,150.75,67,,,percent of total billed charges,67% of total billed charges,150.75,67,,,percent of total billed charges,67% of total billed charges,159.75,71,,,percent of total billed charges,71% of total billed charges,171,76,,,percent of total billed charges,76% of total billed charges,43.52,103,,,Fee Schedule,pays based on EAPG rates,74.16,32.96,,,percent of total billed charges,32.96% of total billed charges,44.37,105,,,Fee Schedule,pays based on EAPG rates,202.5,90,,,percent of total billed charges,90% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,42.26,100,,,Fee Schedule,pays based on EAPG rates,199.35,88.6,,,percent of total billed charges,88.6% of total billed charges,43.52,103,,,Fee Schedule,pays based on EAPG rates,72,32,,,percent of total billed charges,32% of total billed charges,180,80,,,percent of total billed charges,80% of total billed charges,180,80,,,percent of total billed charges,80% of total billed charges,42.26,100,,,Fee Schedule,pays based on EAPG rates,204.75,91,,,percent of total billed charges,91% of total billed charges,73.44,32.64,,,percent of total billed charges,32.64% of total billed charges,72,32,,,percent of total billed charges,32% of total billed charges,75.6,33.6,,,percent of total billed charges,33.6% of total billed charges,43.52,103,,,Fee Schedule,pays based on EAPG rates,72,32,,,percent of total billed charges,32% of total billed charges,72,32,,,percent of total billed charges,32% of total billed charges,207,92,,,percent of total billed charges,92% of total billed charges,42.26,207,
VAGINAL DELIVERY ONLY,1000487,CDM,370,RC,59409,HCPCS,Outpatient,,,8830,7505.5,,7169.96,81.2,,,percent of total billed charges,81.2% of total billed charges,2882.11,32.64,,,percent of total billed charges,32.64% of total billed charges,6534.2,74,,,percent of total billed charges,74% of total billed charges,6534.2,74,,,percent of total billed charges,74% of total billed charges,2825.6,32,,,percent of total billed charges,32% of total billed charges,981.54,103,,,Fee Schedule,pays based on EAPG rates,2825.6,32,,,percent of total billed charges,32% of total billed charges,6269.3,71,,,percent of total billed charges,71% of total billed charges,6269.3,71,,,percent of total billed charges,71% of total billed charges,5916.1,67,,,percent of total billed charges,67% of total billed charges,5916.1,67,,,percent of total billed charges,67% of total billed charges,6269.3,71,,,percent of total billed charges,71% of total billed charges,6710.8,76,,,percent of total billed charges,76% of total billed charges,981.54,103,,,Fee Schedule,pays based on EAPG rates,2910.37,32.96,,,percent of total billed charges,32.96% of total billed charges,1000.59,105,,,Fee Schedule,pays based on EAPG rates,7947,90,,,percent of total billed charges,90% of total billed charges,7947,90,,,percent of total billed charges,90% of total billed charges,952.95,100,,,Fee Schedule,pays based on EAPG rates,7823.38,88.6,,,percent of total billed charges,88.6% of total billed charges,981.54,103,,,Fee Schedule,pays based on EAPG rates,2825.6,32,,,percent of total billed charges,32% of total billed charges,7064,80,,,percent of total billed charges,80% of total billed charges,7064,80,,,percent of total billed charges,80% of total billed charges,952.95,100,,,Fee Schedule,pays based on EAPG rates,8035.3,91,,,percent of total billed charges,91% of total billed charges,2882.11,32.64,,,percent of total billed charges,32.64% of total billed charges,2825.6,32,,,percent of total billed charges,32% of total billed charges,2966.88,33.6,,,percent of total billed charges,33.6% of total billed charges,981.54,103,,,Fee Schedule,pays based on EAPG rates,2825.6,32,,,percent of total billed charges,32% of total billed charges,2825.6,32,,,percent of total billed charges,32% of total billed charges,8123.6,92,,,percent of total billed charges,92% of total billed charges,952.95,8123.6,
SPINAL PUNCTURE LMBR DX W/O FLUORO,1000176,CDM,450,RC,62270,HCPCS,Outpatient,,,1946,1654.1,,1580.15,81.2,,,percent of total billed charges,81.2% of total billed charges,635.17,32.64,,,percent of total billed charges,32.64% of total billed charges,1440.04,74,,,percent of total billed charges,74% of total billed charges,1440.04,74,,,percent of total billed charges,74% of total billed charges,622.72,32,,,percent of total billed charges,32% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,622.72,32,,,percent of total billed charges,32% of total billed charges,1381.66,71,,,percent of total billed charges,71% of total billed charges,1381.66,71,,,percent of total billed charges,71% of total billed charges,1303.82,67,,,percent of total billed charges,67% of total billed charges,1303.82,67,,,percent of total billed charges,67% of total billed charges,1381.66,71,,,percent of total billed charges,71% of total billed charges,1478.96,76,,,percent of total billed charges,76% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,641.4,32.96,,,percent of total billed charges,32.96% of total billed charges,365.8,105,,,Fee Schedule,pays based on EAPG rates,1751.4,90,,,percent of total billed charges,90% of total billed charges,1751.4,90,,,percent of total billed charges,90% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1724.16,88.6,,,percent of total billed charges,88.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,622.72,32,,,percent of total billed charges,32% of total billed charges,1556.8,80,,,percent of total billed charges,80% of total billed charges,1556.8,80,,,percent of total billed charges,80% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1770.86,91,,,percent of total billed charges,91% of total billed charges,635.17,32.64,,,percent of total billed charges,32.64% of total billed charges,622.72,32,,,percent of total billed charges,32% of total billed charges,653.86,33.6,,,percent of total billed charges,33.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,622.72,32,,,percent of total billed charges,32% of total billed charges,622.72,32,,,percent of total billed charges,32% of total billed charges,1790.32,92,,,percent of total billed charges,92% of total billed charges,348.38,1790.32,
INJECTION EPIDURAL BLOOD/CLOT PATCH,1000177,CDM,450,RC,62273,HCPCS,Outpatient,,,1946,1654.1,,1580.15,81.2,,,percent of total billed charges,81.2% of total billed charges,635.17,32.64,,,percent of total billed charges,32.64% of total billed charges,1440.04,74,,,percent of total billed charges,74% of total billed charges,1440.04,74,,,percent of total billed charges,74% of total billed charges,622.72,32,,,percent of total billed charges,32% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,622.72,32,,,percent of total billed charges,32% of total billed charges,1381.66,71,,,percent of total billed charges,71% of total billed charges,1381.66,71,,,percent of total billed charges,71% of total billed charges,1303.82,67,,,percent of total billed charges,67% of total billed charges,1303.82,67,,,percent of total billed charges,67% of total billed charges,1381.66,71,,,percent of total billed charges,71% of total billed charges,1478.96,76,,,percent of total billed charges,76% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,641.4,32.96,,,percent of total billed charges,32.96% of total billed charges,365.8,105,,,Fee Schedule,pays based on EAPG rates,1751.4,90,,,percent of total billed charges,90% of total billed charges,1751.4,90,,,percent of total billed charges,90% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1724.16,88.6,,,percent of total billed charges,88.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,622.72,32,,,percent of total billed charges,32% of total billed charges,1556.8,80,,,percent of total billed charges,80% of total billed charges,1556.8,80,,,percent of total billed charges,80% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1770.86,91,,,percent of total billed charges,91% of total billed charges,635.17,32.64,,,percent of total billed charges,32.64% of total billed charges,622.72,32,,,percent of total billed charges,32% of total billed charges,653.86,33.6,,,percent of total billed charges,33.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,622.72,32,,,percent of total billed charges,32% of total billed charges,622.72,32,,,percent of total billed charges,32% of total billed charges,1790.32,92,,,percent of total billed charges,92% of total billed charges,348.38,1790.32,
INJ ANESTHETIC AGENT TRIGEMINAL NERVE,1000386,CDM,761,RC,64400,HCPCS,Outpatient,,,903,767.55,,733.24,81.2,,,percent of total billed charges,81.2% of total billed charges,294.74,32.64,,,percent of total billed charges,32.64% of total billed charges,668.22,74,,,percent of total billed charges,74% of total billed charges,668.22,74,,,percent of total billed charges,74% of total billed charges,288.96,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,288.96,32,,,percent of total billed charges,32% of total billed charges,641.13,71,,,percent of total billed charges,71% of total billed charges,641.13,71,,,percent of total billed charges,71% of total billed charges,605.01,67,,,percent of total billed charges,67% of total billed charges,605.01,67,,,percent of total billed charges,67% of total billed charges,641.13,71,,,percent of total billed charges,71% of total billed charges,686.28,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,297.63,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,812.7,90,,,percent of total billed charges,90% of total billed charges,812.7,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,800.06,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,288.96,32,,,percent of total billed charges,32% of total billed charges,722.4,80,,,percent of total billed charges,80% of total billed charges,722.4,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,821.73,91,,,percent of total billed charges,91% of total billed charges,294.74,32.64,,,percent of total billed charges,32.64% of total billed charges,288.96,32,,,percent of total billed charges,32% of total billed charges,303.41,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,288.96,32,,,percent of total billed charges,32% of total billed charges,288.96,32,,,percent of total billed charges,32% of total billed charges,830.76,92,,,percent of total billed charges,92% of total billed charges,178.23,830.76,
INJECTION ANESTHETIC AGENT GREATER OCCIP,1000265,CDM,450,RC,64405,HCPCS,Outpatient,,,138,117.3,,112.06,81.2,,,percent of total billed charges,81.2% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,104.88,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,45.48,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,122.27,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,125.58,91,,,percent of total billed charges,91% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,46.37,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,126.96,92,,,percent of total billed charges,92% of total billed charges,44.16,187.15,
NERVE BLOCK INTERCOSTAL NERVE LT,1000456,CDM,450,RC,64420,HCPCS,Outpatient,,,2107,1790.95,,1710.88,81.2,,,percent of total billed charges,81.2% of total billed charges,687.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1559.18,74,,,percent of total billed charges,74% of total billed charges,1559.18,74,,,percent of total billed charges,74% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1411.69,67,,,percent of total billed charges,67% of total billed charges,1411.69,67,,,percent of total billed charges,67% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1601.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,694.47,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1896.3,90,,,percent of total billed charges,90% of total billed charges,1896.3,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1866.8,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,1685.6,80,,,percent of total billed charges,80% of total billed charges,1685.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1917.37,91,,,percent of total billed charges,91% of total billed charges,687.72,32.64,,,percent of total billed charges,32.64% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,707.95,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,1938.44,92,,,percent of total billed charges,92% of total billed charges,178.23,1938.44,
NERVE BLOCK INTERCOSTAL NERVE RT,1000455,CDM,450,RC,64420,HCPCS,Outpatient,,,2107,1790.95,,1710.88,81.2,,,percent of total billed charges,81.2% of total billed charges,687.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1559.18,74,,,percent of total billed charges,74% of total billed charges,1559.18,74,,,percent of total billed charges,74% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1411.69,67,,,percent of total billed charges,67% of total billed charges,1411.69,67,,,percent of total billed charges,67% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1601.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,694.47,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1896.3,90,,,percent of total billed charges,90% of total billed charges,1896.3,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1866.8,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,1685.6,80,,,percent of total billed charges,80% of total billed charges,1685.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1917.37,91,,,percent of total billed charges,91% of total billed charges,687.72,32.64,,,percent of total billed charges,32.64% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,707.95,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,1938.44,92,,,percent of total billed charges,92% of total billed charges,178.23,1938.44,
INJECTION ANESTHETIC AGENT SCIATIC NERVE,1000440,CDM,450,RC,64445,HCPCS,Outpatient,,,2164,1839.4,,1757.17,81.2,,,percent of total billed charges,81.2% of total billed charges,706.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1601.36,74,,,percent of total billed charges,74% of total billed charges,1601.36,74,,,percent of total billed charges,74% of total billed charges,692.48,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,692.48,32,,,percent of total billed charges,32% of total billed charges,1536.44,71,,,percent of total billed charges,71% of total billed charges,1536.44,71,,,percent of total billed charges,71% of total billed charges,1449.88,67,,,percent of total billed charges,67% of total billed charges,1449.88,67,,,percent of total billed charges,67% of total billed charges,1536.44,71,,,percent of total billed charges,71% of total billed charges,1644.64,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,713.25,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1947.6,90,,,percent of total billed charges,90% of total billed charges,1947.6,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1917.3,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,692.48,32,,,percent of total billed charges,32% of total billed charges,1731.2,80,,,percent of total billed charges,80% of total billed charges,1731.2,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1969.24,91,,,percent of total billed charges,91% of total billed charges,706.33,32.64,,,percent of total billed charges,32.64% of total billed charges,692.48,32,,,percent of total billed charges,32% of total billed charges,727.1,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,692.48,32,,,percent of total billed charges,32% of total billed charges,692.48,32,,,percent of total billed charges,32% of total billed charges,1990.88,92,,,percent of total billed charges,92% of total billed charges,178.23,1990.88,
NERVE BLOCK FEMORAL NERVE LT,1000458,CDM,450,RC,64447,HCPCS,Outpatient,,,2107,1790.95,,1710.88,81.2,,,percent of total billed charges,81.2% of total billed charges,687.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1559.18,74,,,percent of total billed charges,74% of total billed charges,1559.18,74,,,percent of total billed charges,74% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1411.69,67,,,percent of total billed charges,67% of total billed charges,1411.69,67,,,percent of total billed charges,67% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1601.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,694.47,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1896.3,90,,,percent of total billed charges,90% of total billed charges,1896.3,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1866.8,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,1685.6,80,,,percent of total billed charges,80% of total billed charges,1685.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1917.37,91,,,percent of total billed charges,91% of total billed charges,687.72,32.64,,,percent of total billed charges,32.64% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,707.95,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,1938.44,92,,,percent of total billed charges,92% of total billed charges,178.23,1938.44,
NERVE BLOCK FEMORAL NERVE RT,1000457,CDM,450,RC,64447,HCPCS,Outpatient,,,2107,1790.95,,1710.88,81.2,,,percent of total billed charges,81.2% of total billed charges,687.72,32.64,,,percent of total billed charges,32.64% of total billed charges,1559.18,74,,,percent of total billed charges,74% of total billed charges,1559.18,74,,,percent of total billed charges,74% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1411.69,67,,,percent of total billed charges,67% of total billed charges,1411.69,67,,,percent of total billed charges,67% of total billed charges,1495.97,71,,,percent of total billed charges,71% of total billed charges,1601.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,694.47,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1896.3,90,,,percent of total billed charges,90% of total billed charges,1896.3,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1866.8,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,1685.6,80,,,percent of total billed charges,80% of total billed charges,1685.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1917.37,91,,,percent of total billed charges,91% of total billed charges,687.72,32.64,,,percent of total billed charges,32.64% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,707.95,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,674.24,32,,,percent of total billed charges,32% of total billed charges,674.24,32,,,percent of total billed charges,32% of total billed charges,1938.44,92,,,percent of total billed charges,92% of total billed charges,178.23,1938.44,
INJ ANESTH AGT OTH PERIPHERAL NERVE BRNC,1000360,CDM,450,RC,64450,HCPCS,Outpatient,,,743,631.55,,603.32,81.2,,,percent of total billed charges,81.2% of total billed charges,242.52,32.64,,,percent of total billed charges,32.64% of total billed charges,549.82,74,,,percent of total billed charges,74% of total billed charges,549.82,74,,,percent of total billed charges,74% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,497.81,67,,,percent of total billed charges,67% of total billed charges,497.81,67,,,percent of total billed charges,67% of total billed charges,527.53,71,,,percent of total billed charges,71% of total billed charges,564.68,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,244.89,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,668.7,90,,,percent of total billed charges,90% of total billed charges,668.7,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,658.3,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,594.4,80,,,percent of total billed charges,80% of total billed charges,594.4,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,676.13,91,,,percent of total billed charges,91% of total billed charges,242.52,32.64,,,percent of total billed charges,32.64% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,249.65,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,237.76,32,,,percent of total billed charges,32% of total billed charges,237.76,32,,,percent of total billed charges,32% of total billed charges,683.56,92,,,percent of total billed charges,92% of total billed charges,178.23,683.56,
NB OTHER PERIPHERAL NERVE/BRANCH B/L,1000444,CDM,450,RC,64450,HCPCS,Outpatient,,,1115,947.75,,905.38,81.2,,,percent of total billed charges,81.2% of total billed charges,363.94,32.64,,,percent of total billed charges,32.64% of total billed charges,825.1,74,,,percent of total billed charges,74% of total billed charges,825.1,74,,,percent of total billed charges,74% of total billed charges,356.8,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,356.8,32,,,percent of total billed charges,32% of total billed charges,791.65,71,,,percent of total billed charges,71% of total billed charges,791.65,71,,,percent of total billed charges,71% of total billed charges,747.05,67,,,percent of total billed charges,67% of total billed charges,747.05,67,,,percent of total billed charges,67% of total billed charges,791.65,71,,,percent of total billed charges,71% of total billed charges,847.4,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,367.5,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,987.89,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,356.8,32,,,percent of total billed charges,32% of total billed charges,892,80,,,percent of total billed charges,80% of total billed charges,892,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1014.65,91,,,percent of total billed charges,91% of total billed charges,363.94,32.64,,,percent of total billed charges,32.64% of total billed charges,356.8,32,,,percent of total billed charges,32% of total billed charges,374.64,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,356.8,32,,,percent of total billed charges,32% of total billed charges,356.8,32,,,percent of total billed charges,32% of total billed charges,1025.8,92,,,percent of total billed charges,92% of total billed charges,178.23,1025.8,
INJECTION ANESTHETIC AGENT FACIAL NERVE,1000359,CDM,450,RC,64999,HCPCS,Outpatient,,,303,257.55,,246.04,81.2,,,percent of total billed charges,81.2% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,230.28,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,99.87,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,272.7,90,,,percent of total billed charges,90% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,268.46,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,275.73,91,,,percent of total billed charges,91% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,101.81,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,278.76,92,,,percent of total billed charges,92% of total billed charges,96.96,278.76,
RMVL FORGN BDY EXT EYE CNJNCT SPRFCL LT,1000339,CDM,450,RC,65205,HCPCS,Outpatient,,,141,119.85,,114.49,81.2,,,percent of total billed charges,81.2% of total billed charges,46.02,32.64,,,percent of total billed charges,32.64% of total billed charges,104.34,74,,,percent of total billed charges,74% of total billed charges,104.34,74,,,percent of total billed charges,74% of total billed charges,45.12,32,,,percent of total billed charges,32% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,45.12,32,,,percent of total billed charges,32% of total billed charges,100.11,71,,,percent of total billed charges,71% of total billed charges,100.11,71,,,percent of total billed charges,71% of total billed charges,94.47,67,,,percent of total billed charges,67% of total billed charges,94.47,67,,,percent of total billed charges,67% of total billed charges,100.11,71,,,percent of total billed charges,71% of total billed charges,107.16,76,,,percent of total billed charges,76% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,46.47,32.96,,,percent of total billed charges,32.96% of total billed charges,31.46,105,,,Fee Schedule,pays based on EAPG rates,126.9,90,,,percent of total billed charges,90% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,124.93,88.6,,,percent of total billed charges,88.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,45.12,32,,,percent of total billed charges,32% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,128.31,91,,,percent of total billed charges,91% of total billed charges,46.02,32.64,,,percent of total billed charges,32.64% of total billed charges,45.12,32,,,percent of total billed charges,32% of total billed charges,47.38,33.6,,,percent of total billed charges,33.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,45.12,32,,,percent of total billed charges,32% of total billed charges,45.12,32,,,percent of total billed charges,32% of total billed charges,129.72,92,,,percent of total billed charges,92% of total billed charges,29.96,129.72,
RMVL FORGN BDY EXT EYE CNJNCT SPRFCL RT,1000338,CDM,450,RC,65205,HCPCS,Outpatient,,,141,119.85,,114.49,81.2,,,percent of total billed charges,81.2% of total billed charges,46.02,32.64,,,percent of total billed charges,32.64% of total billed charges,104.34,74,,,percent of total billed charges,74% of total billed charges,104.34,74,,,percent of total billed charges,74% of total billed charges,45.12,32,,,percent of total billed charges,32% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,45.12,32,,,percent of total billed charges,32% of total billed charges,100.11,71,,,percent of total billed charges,71% of total billed charges,100.11,71,,,percent of total billed charges,71% of total billed charges,94.47,67,,,percent of total billed charges,67% of total billed charges,94.47,67,,,percent of total billed charges,67% of total billed charges,100.11,71,,,percent of total billed charges,71% of total billed charges,107.16,76,,,percent of total billed charges,76% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,46.47,32.96,,,percent of total billed charges,32.96% of total billed charges,31.46,105,,,Fee Schedule,pays based on EAPG rates,126.9,90,,,percent of total billed charges,90% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,124.93,88.6,,,percent of total billed charges,88.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,45.12,32,,,percent of total billed charges,32% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,128.31,91,,,percent of total billed charges,91% of total billed charges,46.02,32.64,,,percent of total billed charges,32.64% of total billed charges,45.12,32,,,percent of total billed charges,32% of total billed charges,47.38,33.6,,,percent of total billed charges,33.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,45.12,32,,,percent of total billed charges,32% of total billed charges,45.12,32,,,percent of total billed charges,32% of total billed charges,129.72,92,,,percent of total billed charges,92% of total billed charges,29.96,129.72,
RMVL FORGN BDY EXT EYE CNJNCT SPRFCL 50,1000340,CDM,450,RC,65205,HCPCS,Outpatient,,,210,178.5,,170.52,81.2,,,percent of total billed charges,81.2% of total billed charges,68.54,32.64,,,percent of total billed charges,32.64% of total billed charges,155.4,74,,,percent of total billed charges,74% of total billed charges,155.4,74,,,percent of total billed charges,74% of total billed charges,67.2,32,,,percent of total billed charges,32% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,67.2,32,,,percent of total billed charges,32% of total billed charges,149.1,71,,,percent of total billed charges,71% of total billed charges,149.1,71,,,percent of total billed charges,71% of total billed charges,140.7,67,,,percent of total billed charges,67% of total billed charges,140.7,67,,,percent of total billed charges,67% of total billed charges,149.1,71,,,percent of total billed charges,71% of total billed charges,159.6,76,,,percent of total billed charges,76% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,69.22,32.96,,,percent of total billed charges,32.96% of total billed charges,31.46,105,,,Fee Schedule,pays based on EAPG rates,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,186.06,88.6,,,percent of total billed charges,88.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,67.2,32,,,percent of total billed charges,32% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,191.1,91,,,percent of total billed charges,91% of total billed charges,68.54,32.64,,,percent of total billed charges,32.64% of total billed charges,67.2,32,,,percent of total billed charges,32% of total billed charges,70.56,33.6,,,percent of total billed charges,33.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,67.2,32,,,percent of total billed charges,32% of total billed charges,67.2,32,,,percent of total billed charges,32% of total billed charges,193.2,92,,,percent of total billed charges,92% of total billed charges,29.96,193.2,
RMVL FRGN BD EXT EYE CRNL WO SLT LMP LT,1000342,CDM,450,RC,65220,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,31.46,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,29.96,122.36,
RMVL FRGN BD EXT EYE CRNL WO SLT LMP RT,1000341,CDM,450,RC,65220,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,31.46,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,29.96,122.36,
RMVL FRGN BD EXT EYE CRNL WO SLT LMP 50,1000343,CDM,450,RC,65220,HCPCS,Outpatient,,,201,170.85,,163.21,81.2,,,percent of total billed charges,81.2% of total billed charges,65.61,32.64,,,percent of total billed charges,32.64% of total billed charges,148.74,74,,,percent of total billed charges,74% of total billed charges,148.74,74,,,percent of total billed charges,74% of total billed charges,64.32,32,,,percent of total billed charges,32% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,64.32,32,,,percent of total billed charges,32% of total billed charges,142.71,71,,,percent of total billed charges,71% of total billed charges,142.71,71,,,percent of total billed charges,71% of total billed charges,134.67,67,,,percent of total billed charges,67% of total billed charges,134.67,67,,,percent of total billed charges,67% of total billed charges,142.71,71,,,percent of total billed charges,71% of total billed charges,152.76,76,,,percent of total billed charges,76% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,66.25,32.96,,,percent of total billed charges,32.96% of total billed charges,31.46,105,,,Fee Schedule,pays based on EAPG rates,180.9,90,,,percent of total billed charges,90% of total billed charges,180.9,90,,,percent of total billed charges,90% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,178.09,88.6,,,percent of total billed charges,88.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,64.32,32,,,percent of total billed charges,32% of total billed charges,160.8,80,,,percent of total billed charges,80% of total billed charges,160.8,80,,,percent of total billed charges,80% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,182.91,91,,,percent of total billed charges,91% of total billed charges,65.61,32.64,,,percent of total billed charges,32.64% of total billed charges,64.32,32,,,percent of total billed charges,32% of total billed charges,67.54,33.6,,,percent of total billed charges,33.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,64.32,32,,,percent of total billed charges,32% of total billed charges,64.32,32,,,percent of total billed charges,32% of total billed charges,184.92,92,,,percent of total billed charges,92% of total billed charges,29.96,184.92,
RMVL FRGN BD EXT EYE CRNL W SLT LMP LT,1000345,CDM,450,RC,65222,HCPCS,Outpatient,,,183,155.55,,148.6,81.2,,,percent of total billed charges,81.2% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,139.08,76,,,percent of total billed charges,76% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,60.32,32.96,,,percent of total billed charges,32.96% of total billed charges,31.46,105,,,Fee Schedule,pays based on EAPG rates,164.7,90,,,percent of total billed charges,90% of total billed charges,164.7,90,,,percent of total billed charges,90% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,162.14,88.6,,,percent of total billed charges,88.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,166.53,91,,,percent of total billed charges,91% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,61.49,33.6,,,percent of total billed charges,33.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,168.36,92,,,percent of total billed charges,92% of total billed charges,29.96,168.36,
RMVL FRGN BD EXT EYE CRNL W SLT LMP RT,1000344,CDM,450,RC,65222,HCPCS,Outpatient,,,183,155.55,,148.6,81.2,,,percent of total billed charges,81.2% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,139.08,76,,,percent of total billed charges,76% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,60.32,32.96,,,percent of total billed charges,32.96% of total billed charges,31.46,105,,,Fee Schedule,pays based on EAPG rates,164.7,90,,,percent of total billed charges,90% of total billed charges,164.7,90,,,percent of total billed charges,90% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,162.14,88.6,,,percent of total billed charges,88.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,166.53,91,,,percent of total billed charges,91% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,61.49,33.6,,,percent of total billed charges,33.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,168.36,92,,,percent of total billed charges,92% of total billed charges,29.96,168.36,
RMVL FRGN BD EXT EYE CRNL W SLT LMP 50,1000346,CDM,450,RC,65222,HCPCS,Outpatient,,,275,233.75,,223.3,81.2,,,percent of total billed charges,81.2% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,209,76,,,percent of total billed charges,76% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,90.64,32.96,,,percent of total billed charges,32.96% of total billed charges,31.46,105,,,Fee Schedule,pays based on EAPG rates,247.5,90,,,percent of total billed charges,90% of total billed charges,247.5,90,,,percent of total billed charges,90% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,243.65,88.6,,,percent of total billed charges,88.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,29.96,100,,,Fee Schedule,pays based on EAPG rates,250.25,91,,,percent of total billed charges,91% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,92.4,33.6,,,percent of total billed charges,33.6% of total billed charges,30.86,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,253,92,,,percent of total billed charges,92% of total billed charges,29.96,253,
"RMVL FB, INTRAOCULAR; FROM ANTE CHAM LT",1000278,CDM,450,RC,65235,HCPCS,Outpatient,,,1235,1049.75,,1002.82,81.2,,,percent of total billed charges,81.2% of total billed charges,403.1,32.64,,,percent of total billed charges,32.64% of total billed charges,913.9,74,,,percent of total billed charges,74% of total billed charges,913.9,74,,,percent of total billed charges,74% of total billed charges,395.2,32,,,percent of total billed charges,32% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,395.2,32,,,percent of total billed charges,32% of total billed charges,876.85,71,,,percent of total billed charges,71% of total billed charges,876.85,71,,,percent of total billed charges,71% of total billed charges,827.45,67,,,percent of total billed charges,67% of total billed charges,827.45,67,,,percent of total billed charges,67% of total billed charges,876.85,71,,,percent of total billed charges,71% of total billed charges,938.6,76,,,percent of total billed charges,76% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,407.06,32.96,,,percent of total billed charges,32.96% of total billed charges,246.54,105,,,Fee Schedule,pays based on EAPG rates,1111.5,90,,,percent of total billed charges,90% of total billed charges,1111.5,90,,,percent of total billed charges,90% of total billed charges,234.8,100,,,Fee Schedule,pays based on EAPG rates,1094.21,88.6,,,percent of total billed charges,88.6% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,395.2,32,,,percent of total billed charges,32% of total billed charges,988,80,,,percent of total billed charges,80% of total billed charges,988,80,,,percent of total billed charges,80% of total billed charges,234.8,100,,,Fee Schedule,pays based on EAPG rates,1123.85,91,,,percent of total billed charges,91% of total billed charges,403.1,32.64,,,percent of total billed charges,32.64% of total billed charges,395.2,32,,,percent of total billed charges,32% of total billed charges,414.96,33.6,,,percent of total billed charges,33.6% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,395.2,32,,,percent of total billed charges,32% of total billed charges,395.2,32,,,percent of total billed charges,32% of total billed charges,1136.2,92,,,percent of total billed charges,92% of total billed charges,234.8,1136.2,
"RMVL FB, INTRAOCULAR; FROM ANTER CHAM RT",1000276,CDM,450,RC,65235,HCPCS,Outpatient,,,1235,1049.75,,1002.82,81.2,,,percent of total billed charges,81.2% of total billed charges,403.1,32.64,,,percent of total billed charges,32.64% of total billed charges,913.9,74,,,percent of total billed charges,74% of total billed charges,913.9,74,,,percent of total billed charges,74% of total billed charges,395.2,32,,,percent of total billed charges,32% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,395.2,32,,,percent of total billed charges,32% of total billed charges,876.85,71,,,percent of total billed charges,71% of total billed charges,876.85,71,,,percent of total billed charges,71% of total billed charges,827.45,67,,,percent of total billed charges,67% of total billed charges,827.45,67,,,percent of total billed charges,67% of total billed charges,876.85,71,,,percent of total billed charges,71% of total billed charges,938.6,76,,,percent of total billed charges,76% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,407.06,32.96,,,percent of total billed charges,32.96% of total billed charges,246.54,105,,,Fee Schedule,pays based on EAPG rates,1111.5,90,,,percent of total billed charges,90% of total billed charges,1111.5,90,,,percent of total billed charges,90% of total billed charges,234.8,100,,,Fee Schedule,pays based on EAPG rates,1094.21,88.6,,,percent of total billed charges,88.6% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,395.2,32,,,percent of total billed charges,32% of total billed charges,988,80,,,percent of total billed charges,80% of total billed charges,988,80,,,percent of total billed charges,80% of total billed charges,234.8,100,,,Fee Schedule,pays based on EAPG rates,1123.85,91,,,percent of total billed charges,91% of total billed charges,403.1,32.64,,,percent of total billed charges,32.64% of total billed charges,395.2,32,,,percent of total billed charges,32% of total billed charges,414.96,33.6,,,percent of total billed charges,33.6% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,395.2,32,,,percent of total billed charges,32% of total billed charges,395.2,32,,,percent of total billed charges,32% of total billed charges,1136.2,92,,,percent of total billed charges,92% of total billed charges,234.8,1136.2,
"RMVL FB, INTRAOCULAR; FROM ANTER CHAM 50",1000347,CDM,450,RC,65235,HCPCS,Outpatient,,,1763,1498.55,,1431.56,81.2,,,percent of total billed charges,81.2% of total billed charges,575.44,32.64,,,percent of total billed charges,32.64% of total billed charges,1304.62,74,,,percent of total billed charges,74% of total billed charges,1304.62,74,,,percent of total billed charges,74% of total billed charges,564.16,32,,,percent of total billed charges,32% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,564.16,32,,,percent of total billed charges,32% of total billed charges,1251.73,71,,,percent of total billed charges,71% of total billed charges,1251.73,71,,,percent of total billed charges,71% of total billed charges,1181.21,67,,,percent of total billed charges,67% of total billed charges,1181.21,67,,,percent of total billed charges,67% of total billed charges,1251.73,71,,,percent of total billed charges,71% of total billed charges,1339.88,76,,,percent of total billed charges,76% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,581.08,32.96,,,percent of total billed charges,32.96% of total billed charges,246.54,105,,,Fee Schedule,pays based on EAPG rates,1586.7,90,,,percent of total billed charges,90% of total billed charges,1586.7,90,,,percent of total billed charges,90% of total billed charges,234.8,100,,,Fee Schedule,pays based on EAPG rates,1562.02,88.6,,,percent of total billed charges,88.6% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,564.16,32,,,percent of total billed charges,32% of total billed charges,1410.4,80,,,percent of total billed charges,80% of total billed charges,1410.4,80,,,percent of total billed charges,80% of total billed charges,234.8,100,,,Fee Schedule,pays based on EAPG rates,1604.33,91,,,percent of total billed charges,91% of total billed charges,575.44,32.64,,,percent of total billed charges,32.64% of total billed charges,564.16,32,,,percent of total billed charges,32% of total billed charges,592.37,33.6,,,percent of total billed charges,33.6% of total billed charges,241.84,103,,,Fee Schedule,pays based on EAPG rates,564.16,32,,,percent of total billed charges,32% of total billed charges,564.16,32,,,percent of total billed charges,32% of total billed charges,1621.96,92,,,percent of total billed charges,92% of total billed charges,234.8,1621.96,
"BLEP, DRAIN ABSCESS EYELID LOWER LEFT",1000349,CDM,450,RC,67700,HCPCS,Outpatient,,,228,193.8,,185.14,81.2,,,percent of total billed charges,81.2% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,173.28,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,75.15,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,202.01,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,207.48,91,,,percent of total billed charges,91% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,76.61,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,209.76,92,,,percent of total billed charges,92% of total billed charges,72.96,209.76,
"BLEP, DRAIN ABSCESS EYELID LOWER RIGHT",1000351,CDM,450,RC,67700,HCPCS,Outpatient,,,228,193.8,,185.14,81.2,,,percent of total billed charges,81.2% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,173.28,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,75.15,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,202.01,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,207.48,91,,,percent of total billed charges,91% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,76.61,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,209.76,92,,,percent of total billed charges,92% of total billed charges,72.96,209.76,
"BLEP, DRAIN ABSCESS EYELID UPPER RIGHT",1000348,CDM,450,RC,67700,HCPCS,Outpatient,,,228,193.8,,185.14,81.2,,,percent of total billed charges,81.2% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,173.28,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,75.15,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,202.01,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,207.48,91,,,percent of total billed charges,91% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,76.61,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,209.76,92,,,percent of total billed charges,92% of total billed charges,72.96,209.76,
"BLEP, DRAIN ABSCESS EYELID UPPER RIGHT",1000350,CDM,450,RC,67700,HCPCS,Outpatient,,,228,193.8,,185.14,81.2,,,percent of total billed charges,81.2% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,173.28,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,75.15,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,202.01,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,207.48,91,,,percent of total billed charges,91% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,76.61,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,32,,,percent of total billed charges,32% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,209.76,92,,,percent of total billed charges,92% of total billed charges,72.96,209.76,
RMVL EMBED FOREIGN BODY EYELID LOW LT,1000353,CDM,450,RC,67938,HCPCS,Outpatient,,,226,192.1,,183.51,81.2,,,percent of total billed charges,81.2% of total billed charges,73.77,32.64,,,percent of total billed charges,32.64% of total billed charges,167.24,74,,,percent of total billed charges,74% of total billed charges,167.24,74,,,percent of total billed charges,74% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,151.42,67,,,percent of total billed charges,67% of total billed charges,151.42,67,,,percent of total billed charges,67% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,171.76,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,74.49,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,203.4,90,,,percent of total billed charges,90% of total billed charges,203.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,200.24,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,180.8,80,,,percent of total billed charges,80% of total billed charges,180.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,205.66,91,,,percent of total billed charges,91% of total billed charges,73.77,32.64,,,percent of total billed charges,32.64% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,75.94,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,207.92,92,,,percent of total billed charges,92% of total billed charges,72.32,207.92,
RMVL EMBED FOREIGN BODY EYELID LOW RT,1000355,CDM,450,RC,67938,HCPCS,Outpatient,,,226,192.1,,183.51,81.2,,,percent of total billed charges,81.2% of total billed charges,73.77,32.64,,,percent of total billed charges,32.64% of total billed charges,167.24,74,,,percent of total billed charges,74% of total billed charges,167.24,74,,,percent of total billed charges,74% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,151.42,67,,,percent of total billed charges,67% of total billed charges,151.42,67,,,percent of total billed charges,67% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,171.76,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,74.49,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,203.4,90,,,percent of total billed charges,90% of total billed charges,203.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,200.24,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,180.8,80,,,percent of total billed charges,80% of total billed charges,180.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,205.66,91,,,percent of total billed charges,91% of total billed charges,73.77,32.64,,,percent of total billed charges,32.64% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,75.94,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,207.92,92,,,percent of total billed charges,92% of total billed charges,72.32,207.92,
RMVL EMBED FOREIGN BODY EYELID UP LT,1000352,CDM,450,RC,67938,HCPCS,Outpatient,,,226,192.1,,183.51,81.2,,,percent of total billed charges,81.2% of total billed charges,73.77,32.64,,,percent of total billed charges,32.64% of total billed charges,167.24,74,,,percent of total billed charges,74% of total billed charges,167.24,74,,,percent of total billed charges,74% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,151.42,67,,,percent of total billed charges,67% of total billed charges,151.42,67,,,percent of total billed charges,67% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,171.76,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,74.49,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,203.4,90,,,percent of total billed charges,90% of total billed charges,203.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,200.24,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,180.8,80,,,percent of total billed charges,80% of total billed charges,180.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,205.66,91,,,percent of total billed charges,91% of total billed charges,73.77,32.64,,,percent of total billed charges,32.64% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,75.94,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,207.92,92,,,percent of total billed charges,92% of total billed charges,72.32,207.92,
RMVL EMBED FOREIGN BODY EYELID UP RT,1000354,CDM,450,RC,67938,HCPCS,Outpatient,,,226,192.1,,183.51,81.2,,,percent of total billed charges,81.2% of total billed charges,73.77,32.64,,,percent of total billed charges,32.64% of total billed charges,167.24,74,,,percent of total billed charges,74% of total billed charges,167.24,74,,,percent of total billed charges,74% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,151.42,67,,,percent of total billed charges,67% of total billed charges,151.42,67,,,percent of total billed charges,67% of total billed charges,160.46,71,,,percent of total billed charges,71% of total billed charges,171.76,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,74.49,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,203.4,90,,,percent of total billed charges,90% of total billed charges,203.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,200.24,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,180.8,80,,,percent of total billed charges,80% of total billed charges,180.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,205.66,91,,,percent of total billed charges,91% of total billed charges,73.77,32.64,,,percent of total billed charges,32.64% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,75.94,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,72.32,32,,,percent of total billed charges,32% of total billed charges,72.32,32,,,percent of total billed charges,32% of total billed charges,207.92,92,,,percent of total billed charges,92% of total billed charges,72.32,207.92,
DRAIN EXT EAR ABSCESS/HEMATOMA SIMP LT,1000452,CDM,450,RC,69000,HCPCS,Outpatient,,,376,319.6,,305.31,81.2,,,percent of total billed charges,81.2% of total billed charges,122.73,32.64,,,percent of total billed charges,32.64% of total billed charges,278.24,74,,,percent of total billed charges,74% of total billed charges,278.24,74,,,percent of total billed charges,74% of total billed charges,120.32,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,120.32,32,,,percent of total billed charges,32% of total billed charges,266.96,71,,,percent of total billed charges,71% of total billed charges,266.96,71,,,percent of total billed charges,71% of total billed charges,251.92,67,,,percent of total billed charges,67% of total billed charges,251.92,67,,,percent of total billed charges,67% of total billed charges,266.96,71,,,percent of total billed charges,71% of total billed charges,285.76,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,123.93,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,338.4,90,,,percent of total billed charges,90% of total billed charges,338.4,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,333.14,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,120.32,32,,,percent of total billed charges,32% of total billed charges,300.8,80,,,percent of total billed charges,80% of total billed charges,300.8,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,342.16,91,,,percent of total billed charges,91% of total billed charges,122.73,32.64,,,percent of total billed charges,32.64% of total billed charges,120.32,32,,,percent of total billed charges,32% of total billed charges,126.34,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,120.32,32,,,percent of total billed charges,32% of total billed charges,120.32,32,,,percent of total billed charges,32% of total billed charges,345.92,92,,,percent of total billed charges,92% of total billed charges,66.31,345.92,
DRAIN EXT EAR ABSCESS/HEMATOMA SIMP RT,1000451,CDM,450,RC,69000,HCPCS,Outpatient,,,376,319.6,,305.31,81.2,,,percent of total billed charges,81.2% of total billed charges,122.73,32.64,,,percent of total billed charges,32.64% of total billed charges,278.24,74,,,percent of total billed charges,74% of total billed charges,278.24,74,,,percent of total billed charges,74% of total billed charges,120.32,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,120.32,32,,,percent of total billed charges,32% of total billed charges,266.96,71,,,percent of total billed charges,71% of total billed charges,266.96,71,,,percent of total billed charges,71% of total billed charges,251.92,67,,,percent of total billed charges,67% of total billed charges,251.92,67,,,percent of total billed charges,67% of total billed charges,266.96,71,,,percent of total billed charges,71% of total billed charges,285.76,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,123.93,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,338.4,90,,,percent of total billed charges,90% of total billed charges,338.4,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,333.14,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,120.32,32,,,percent of total billed charges,32% of total billed charges,300.8,80,,,percent of total billed charges,80% of total billed charges,300.8,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,342.16,91,,,percent of total billed charges,91% of total billed charges,122.73,32.64,,,percent of total billed charges,32.64% of total billed charges,120.32,32,,,percent of total billed charges,32% of total billed charges,126.34,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,120.32,32,,,percent of total billed charges,32% of total billed charges,120.32,32,,,percent of total billed charges,32% of total billed charges,345.92,92,,,percent of total billed charges,92% of total billed charges,66.31,345.92,
DRAIN EXT EAR ABSCESS/HEMATOMA SIMP B/L,1000453,CDM,450,RC,69000,HCPCS,Outpatient,,,563,478.55,,457.16,81.2,,,percent of total billed charges,81.2% of total billed charges,183.76,32.64,,,percent of total billed charges,32.64% of total billed charges,416.62,74,,,percent of total billed charges,74% of total billed charges,416.62,74,,,percent of total billed charges,74% of total billed charges,180.16,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,180.16,32,,,percent of total billed charges,32% of total billed charges,399.73,71,,,percent of total billed charges,71% of total billed charges,399.73,71,,,percent of total billed charges,71% of total billed charges,377.21,67,,,percent of total billed charges,67% of total billed charges,377.21,67,,,percent of total billed charges,67% of total billed charges,399.73,71,,,percent of total billed charges,71% of total billed charges,427.88,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,185.56,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,506.7,90,,,percent of total billed charges,90% of total billed charges,506.7,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,498.82,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,180.16,32,,,percent of total billed charges,32% of total billed charges,450.4,80,,,percent of total billed charges,80% of total billed charges,450.4,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,512.33,91,,,percent of total billed charges,91% of total billed charges,183.76,32.64,,,percent of total billed charges,32.64% of total billed charges,180.16,32,,,percent of total billed charges,32% of total billed charges,189.17,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,180.16,32,,,percent of total billed charges,32% of total billed charges,180.16,32,,,percent of total billed charges,32% of total billed charges,517.96,92,,,percent of total billed charges,92% of total billed charges,66.31,517.96,
DRAIN EXT EAR ABSCESS/HEMATOMA COMPLICAT,1000182,CDM,450,RC,69005,HCPCS,Outpatient,,,370,314.5,,300.44,81.2,,,percent of total billed charges,81.2% of total billed charges,120.77,32.64,,,percent of total billed charges,32.64% of total billed charges,273.8,74,,,percent of total billed charges,74% of total billed charges,273.8,74,,,percent of total billed charges,74% of total billed charges,118.4,32,,,percent of total billed charges,32% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,118.4,32,,,percent of total billed charges,32% of total billed charges,262.7,71,,,percent of total billed charges,71% of total billed charges,262.7,71,,,percent of total billed charges,71% of total billed charges,247.9,67,,,percent of total billed charges,67% of total billed charges,247.9,67,,,percent of total billed charges,67% of total billed charges,262.7,71,,,percent of total billed charges,71% of total billed charges,281.2,76,,,percent of total billed charges,76% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,121.95,32.96,,,percent of total billed charges,32.96% of total billed charges,607.78,105,,,Fee Schedule,pays based on EAPG rates,333,90,,,percent of total billed charges,90% of total billed charges,333,90,,,percent of total billed charges,90% of total billed charges,578.84,100,,,Fee Schedule,pays based on EAPG rates,327.82,88.6,,,percent of total billed charges,88.6% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,118.4,32,,,percent of total billed charges,32% of total billed charges,296,80,,,percent of total billed charges,80% of total billed charges,296,80,,,percent of total billed charges,80% of total billed charges,578.84,100,,,Fee Schedule,pays based on EAPG rates,336.7,91,,,percent of total billed charges,91% of total billed charges,120.77,32.64,,,percent of total billed charges,32.64% of total billed charges,118.4,32,,,percent of total billed charges,32% of total billed charges,124.32,33.6,,,percent of total billed charges,33.6% of total billed charges,596.2,103,,,Fee Schedule,pays based on EAPG rates,118.4,32,,,percent of total billed charges,32% of total billed charges,118.4,32,,,percent of total billed charges,32% of total billed charges,340.4,92,,,percent of total billed charges,92% of total billed charges,118.4,607.78,
RMVL FRGN BD EXT AUD CANAL W/O ANES LT,1000371,CDM,450,RC,69200,HCPCS,Outpatient,,,264,224.4,,214.37,81.2,,,percent of total billed charges,81.2% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,200.64,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,87.01,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,237.6,90,,,percent of total billed charges,90% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,233.9,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,240.24,91,,,percent of total billed charges,91% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,88.7,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,242.88,92,,,percent of total billed charges,92% of total billed charges,66.31,242.88,
RMVL FRGN BD EXT AUD CANAL W/O ANES RT,1000372,CDM,450,RC,69200,HCPCS,Outpatient,,,264,224.4,,214.37,81.2,,,percent of total billed charges,81.2% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,200.64,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,87.01,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,237.6,90,,,percent of total billed charges,90% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,233.9,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,240.24,91,,,percent of total billed charges,91% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,88.7,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,242.88,92,,,percent of total billed charges,92% of total billed charges,66.31,242.88,
RMVL FRGN BD EXT AUD CANAL W/O ANES B/L,1000373,CDM,450,RC,69200,HCPCS,Outpatient,,,395,335.75,,320.74,81.2,,,percent of total billed charges,81.2% of total billed charges,128.93,32.64,,,percent of total billed charges,32.64% of total billed charges,292.3,74,,,percent of total billed charges,74% of total billed charges,292.3,74,,,percent of total billed charges,74% of total billed charges,126.4,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,126.4,32,,,percent of total billed charges,32% of total billed charges,280.45,71,,,percent of total billed charges,71% of total billed charges,280.45,71,,,percent of total billed charges,71% of total billed charges,264.65,67,,,percent of total billed charges,67% of total billed charges,264.65,67,,,percent of total billed charges,67% of total billed charges,280.45,71,,,percent of total billed charges,71% of total billed charges,300.2,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,130.19,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,349.97,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,126.4,32,,,percent of total billed charges,32% of total billed charges,316,80,,,percent of total billed charges,80% of total billed charges,316,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,359.45,91,,,percent of total billed charges,91% of total billed charges,128.93,32.64,,,percent of total billed charges,32.64% of total billed charges,126.4,32,,,percent of total billed charges,32% of total billed charges,132.72,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,126.4,32,,,percent of total billed charges,32% of total billed charges,126.4,32,,,percent of total billed charges,32% of total billed charges,363.4,92,,,percent of total billed charges,92% of total billed charges,66.31,363.4,
RMVL IMPACT CERUMEN IRR/LVG UNILAT,1000274,CDM,450,RC,69209,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,15.36,69.63,
RMVL IMPACT CERUMEN IRR/LVG BILAT,1000391,CDM,450,RC,69209,HCPCS,Outpatient,,,73,62.05,,59.28,81.2,,,percent of total billed charges,81.2% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,55.48,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,24.06,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,64.68,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,66.43,91,,,percent of total billed charges,91% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,24.53,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,67.16,92,,,percent of total billed charges,92% of total billed charges,23.36,69.63,
RMVL IMPACTED CERUMEN 1 OR BOTH EARS,1000184,CDM,450,RC,69210,HCPCS,Outpatient,,,105,89.25,,85.26,81.2,,,percent of total billed charges,81.2% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,79.8,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,34.61,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,94.5,90,,,percent of total billed charges,90% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,93.03,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,95.55,91,,,percent of total billed charges,91% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,35.28,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,96.6,92,,,percent of total billed charges,92% of total billed charges,33.6,96.6,
US OPHTHALMIC DX B-SCAN W/WO A LT,1000481,CDM,450,RC,76512,HCPCS,Outpatient,,,361,306.85,,293.13,81.2,,,percent of total billed charges,81.2% of total billed charges,117.83,32.64,,,percent of total billed charges,32.64% of total billed charges,267.14,74,,,percent of total billed charges,74% of total billed charges,267.14,74,,,percent of total billed charges,74% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,241.87,67,,,percent of total billed charges,67% of total billed charges,241.87,67,,,percent of total billed charges,67% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,274.36,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,118.99,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,324.9,90,,,percent of total billed charges,90% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,319.85,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,288.8,80,,,percent of total billed charges,80% of total billed charges,288.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,328.51,91,,,percent of total billed charges,91% of total billed charges,117.83,32.64,,,percent of total billed charges,32.64% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,121.3,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,332.12,92,,,percent of total billed charges,92% of total billed charges,60.19,332.12,
US OPHTHALMIC DX B-SCAN W/WO A RT,1000482,CDM,450,RC,76512,HCPCS,Outpatient,,,361,306.85,,293.13,81.2,,,percent of total billed charges,81.2% of total billed charges,117.83,32.64,,,percent of total billed charges,32.64% of total billed charges,267.14,74,,,percent of total billed charges,74% of total billed charges,267.14,74,,,percent of total billed charges,74% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,241.87,67,,,percent of total billed charges,67% of total billed charges,241.87,67,,,percent of total billed charges,67% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,274.36,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,118.99,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,324.9,90,,,percent of total billed charges,90% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,319.85,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,288.8,80,,,percent of total billed charges,80% of total billed charges,288.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,328.51,91,,,percent of total billed charges,91% of total billed charges,117.83,32.64,,,percent of total billed charges,32.64% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,121.3,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,332.12,92,,,percent of total billed charges,92% of total billed charges,60.19,332.12,
US CHEST/MEDIASTINUM REAL TIME,1000402,CDM,450,RC,76604,HCPCS,Outpatient,,,344,292.4,,279.33,81.2,,,percent of total billed charges,81.2% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,261.44,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,113.38,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,304.78,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,313.04,91,,,percent of total billed charges,91% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,115.58,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,316.48,92,,,percent of total billed charges,92% of total billed charges,60.19,316.48,
US ABDOMINAL REAL TIME LIMITED,1000403,CDM,402,RC,76705,HCPCS,Outpatient,,,593,504.05,,481.52,81.2,,,percent of total billed charges,81.2% of total billed charges,193.56,32.64,,,percent of total billed charges,32.64% of total billed charges,438.82,74,,,percent of total billed charges,74% of total billed charges,438.82,74,,,percent of total billed charges,74% of total billed charges,189.76,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,189.76,32,,,percent of total billed charges,32% of total billed charges,421.03,71,,,percent of total billed charges,71% of total billed charges,421.03,71,,,percent of total billed charges,71% of total billed charges,397.31,67,,,percent of total billed charges,67% of total billed charges,397.31,67,,,percent of total billed charges,67% of total billed charges,421.03,71,,,percent of total billed charges,71% of total billed charges,450.68,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,195.45,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,533.7,90,,,percent of total billed charges,90% of total billed charges,533.7,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,525.4,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,189.76,32,,,percent of total billed charges,32% of total billed charges,474.4,80,,,percent of total billed charges,80% of total billed charges,474.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,539.63,91,,,percent of total billed charges,91% of total billed charges,193.56,32.64,,,percent of total billed charges,32.64% of total billed charges,189.76,32,,,percent of total billed charges,32% of total billed charges,199.25,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,189.76,32,,,percent of total billed charges,32% of total billed charges,189.76,32,,,percent of total billed charges,32% of total billed charges,545.56,92,,,percent of total billed charges,92% of total billed charges,60.19,545.56,
US RETROPERITONEAL REAL TIME LIMITED,1000404,CDM,402,RC,76775,HCPCS,Outpatient,,,593,504.05,,481.52,81.2,,,percent of total billed charges,81.2% of total billed charges,193.56,32.64,,,percent of total billed charges,32.64% of total billed charges,438.82,74,,,percent of total billed charges,74% of total billed charges,438.82,74,,,percent of total billed charges,74% of total billed charges,189.76,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,189.76,32,,,percent of total billed charges,32% of total billed charges,421.03,71,,,percent of total billed charges,71% of total billed charges,421.03,71,,,percent of total billed charges,71% of total billed charges,397.31,67,,,percent of total billed charges,67% of total billed charges,397.31,67,,,percent of total billed charges,67% of total billed charges,421.03,71,,,percent of total billed charges,71% of total billed charges,450.68,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,195.45,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,533.7,90,,,percent of total billed charges,90% of total billed charges,533.7,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,525.4,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,189.76,32,,,percent of total billed charges,32% of total billed charges,474.4,80,,,percent of total billed charges,80% of total billed charges,474.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,539.63,91,,,percent of total billed charges,91% of total billed charges,193.56,32.64,,,percent of total billed charges,32.64% of total billed charges,189.76,32,,,percent of total billed charges,32% of total billed charges,199.25,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,189.76,32,,,percent of total billed charges,32% of total billed charges,189.76,32,,,percent of total billed charges,32% of total billed charges,545.56,92,,,percent of total billed charges,92% of total billed charges,60.19,545.56,
US PREG UTERUS REAL TIME LIMITED,1000405,CDM,402,RC,76815,HCPCS,Outpatient,,,415,352.75,,336.98,81.2,,,percent of total billed charges,81.2% of total billed charges,135.46,32.64,,,percent of total billed charges,32.64% of total billed charges,307.1,74,,,percent of total billed charges,74% of total billed charges,307.1,74,,,percent of total billed charges,74% of total billed charges,132.8,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,132.8,32,,,percent of total billed charges,32% of total billed charges,294.65,71,,,percent of total billed charges,71% of total billed charges,294.65,71,,,percent of total billed charges,71% of total billed charges,278.05,67,,,percent of total billed charges,67% of total billed charges,278.05,67,,,percent of total billed charges,67% of total billed charges,294.65,71,,,percent of total billed charges,71% of total billed charges,315.4,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,136.78,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,373.5,90,,,percent of total billed charges,90% of total billed charges,373.5,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,367.69,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,132.8,32,,,percent of total billed charges,32% of total billed charges,332,80,,,percent of total billed charges,80% of total billed charges,332,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,377.65,91,,,percent of total billed charges,91% of total billed charges,135.46,32.64,,,percent of total billed charges,32.64% of total billed charges,132.8,32,,,percent of total billed charges,32% of total billed charges,139.44,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,132.8,32,,,percent of total billed charges,32% of total billed charges,132.8,32,,,percent of total billed charges,32% of total billed charges,381.8,92,,,percent of total billed charges,92% of total billed charges,72.01,381.8,
US PREG UTERUS REAL TIME TRANSVAG,1000406,CDM,402,RC,76817,HCPCS,Outpatient,,,778,661.3,,631.74,81.2,,,percent of total billed charges,81.2% of total billed charges,253.94,32.64,,,percent of total billed charges,32.64% of total billed charges,575.72,74,,,percent of total billed charges,74% of total billed charges,575.72,74,,,percent of total billed charges,74% of total billed charges,248.96,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,248.96,32,,,percent of total billed charges,32% of total billed charges,552.38,71,,,percent of total billed charges,71% of total billed charges,552.38,71,,,percent of total billed charges,71% of total billed charges,521.26,67,,,percent of total billed charges,67% of total billed charges,521.26,67,,,percent of total billed charges,67% of total billed charges,552.38,71,,,percent of total billed charges,71% of total billed charges,591.28,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,256.43,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,700.2,90,,,percent of total billed charges,90% of total billed charges,700.2,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,689.31,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,248.96,32,,,percent of total billed charges,32% of total billed charges,622.4,80,,,percent of total billed charges,80% of total billed charges,622.4,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,707.98,91,,,percent of total billed charges,91% of total billed charges,253.94,32.64,,,percent of total billed charges,32.64% of total billed charges,248.96,32,,,percent of total billed charges,32% of total billed charges,261.41,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,248.96,32,,,percent of total billed charges,32% of total billed charges,248.96,32,,,percent of total billed charges,32% of total billed charges,715.76,92,,,percent of total billed charges,92% of total billed charges,72.01,715.76,
US JOINT NONVAS EXT REAL TIME,1000407,CDM,402,RC,76882,HCPCS,Outpatient,,,325,276.25,,263.9,81.2,,,percent of total billed charges,81.2% of total billed charges,106.08,32.64,,,percent of total billed charges,32.64% of total billed charges,240.5,74,,,percent of total billed charges,74% of total billed charges,240.5,74,,,percent of total billed charges,74% of total billed charges,104,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,104,32,,,percent of total billed charges,32% of total billed charges,230.75,71,,,percent of total billed charges,71% of total billed charges,230.75,71,,,percent of total billed charges,71% of total billed charges,217.75,67,,,percent of total billed charges,67% of total billed charges,217.75,67,,,percent of total billed charges,67% of total billed charges,230.75,71,,,percent of total billed charges,71% of total billed charges,247,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,107.12,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,292.5,90,,,percent of total billed charges,90% of total billed charges,292.5,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,287.95,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,104,32,,,percent of total billed charges,32% of total billed charges,260,80,,,percent of total billed charges,80% of total billed charges,260,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,295.75,91,,,percent of total billed charges,91% of total billed charges,106.08,32.64,,,percent of total billed charges,32.64% of total billed charges,104,32,,,percent of total billed charges,32% of total billed charges,109.2,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,104,32,,,percent of total billed charges,32% of total billed charges,104,32,,,percent of total billed charges,32% of total billed charges,299,92,,,percent of total billed charges,92% of total billed charges,60.19,299,
US GUIDE VASC ACCESS,1000408,CDM,402,RC,76937,HCPCS,Outpatient,,,92,78.2,,74.7,81.2,,,percent of total billed charges,81.2% of total billed charges,30.03,32.64,,,percent of total billed charges,32.64% of total billed charges,68.08,74,,,percent of total billed charges,74% of total billed charges,68.08,74,,,percent of total billed charges,74% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,61.64,67,,,percent of total billed charges,67% of total billed charges,61.64,67,,,percent of total billed charges,67% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,69.92,76,,,percent of total billed charges,76% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,30.32,32.96,,,percent of total billed charges,32.96% of total billed charges,60.29,105,,,Fee Schedule,pays based on EAPG rates,82.8,90,,,percent of total billed charges,90% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,81.51,88.6,,,percent of total billed charges,88.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,73.6,80,,,percent of total billed charges,80% of total billed charges,73.6,80,,,percent of total billed charges,80% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,83.72,91,,,percent of total billed charges,91% of total billed charges,30.03,32.64,,,percent of total billed charges,32.64% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,30.91,33.6,,,percent of total billed charges,33.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,84.64,92,,,percent of total billed charges,92% of total billed charges,29.44,84.64,
IMMUN/VACCINE ADMIN ONE,1000022,CDM,771,RC,90471,HCPCS,Outpatient,,,44,37.4,,35.73,81.2,,,percent of total billed charges,81.2% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,33.44,76,,,percent of total billed charges,76% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,14.5,32.96,,,percent of total billed charges,32.96% of total billed charges,11.05,105,,,Fee Schedule,pays based on EAPG rates,39.6,90,,,percent of total billed charges,90% of total billed charges,39.6,90,,,percent of total billed charges,90% of total billed charges,10.52,100,,,Fee Schedule,pays based on EAPG rates,38.98,88.6,,,percent of total billed charges,88.6% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,10.52,100,,,Fee Schedule,pays based on EAPG rates,40.04,91,,,percent of total billed charges,91% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,14.78,33.6,,,percent of total billed charges,33.6% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,40.48,92,,,percent of total billed charges,92% of total billed charges,10.52,40.48,
IMMUN/VACCINE ADMIN EA ADDIT,1000023,CDM,771,RC,90472,HCPCS,Outpatient,,,42,35.7,,34.1,81.2,,,percent of total billed charges,81.2% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,31.92,76,,,percent of total billed charges,76% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.84,32.96,,,percent of total billed charges,32.96% of total billed charges,11.05,105,,,Fee Schedule,pays based on EAPG rates,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,10.52,100,,,Fee Schedule,pays based on EAPG rates,37.21,88.6,,,percent of total billed charges,88.6% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.52,100,,,Fee Schedule,pays based on EAPG rates,38.22,91,,,percent of total billed charges,91% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,14.11,33.6,,,percent of total billed charges,33.6% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,38.64,92,,,percent of total billed charges,92% of total billed charges,10.52,38.64,
TEMP TRANSCUTANEOUS PACING,1000416,CDM,450,RC,92953,HCPCS,Outpatient,,,646,549.1,,524.55,81.2,,,percent of total billed charges,81.2% of total billed charges,210.85,32.64,,,percent of total billed charges,32.64% of total billed charges,478.04,74,,,percent of total billed charges,74% of total billed charges,478.04,74,,,percent of total billed charges,74% of total billed charges,206.72,32,,,percent of total billed charges,32% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,206.72,32,,,percent of total billed charges,32% of total billed charges,458.66,71,,,percent of total billed charges,71% of total billed charges,458.66,71,,,percent of total billed charges,71% of total billed charges,432.82,67,,,percent of total billed charges,67% of total billed charges,432.82,67,,,percent of total billed charges,67% of total billed charges,458.66,71,,,percent of total billed charges,71% of total billed charges,490.96,76,,,percent of total billed charges,76% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,212.92,32.96,,,percent of total billed charges,32.96% of total billed charges,257.15,105,,,Fee Schedule,pays based on EAPG rates,581.4,90,,,percent of total billed charges,90% of total billed charges,581.4,90,,,percent of total billed charges,90% of total billed charges,244.9,100,,,Fee Schedule,pays based on EAPG rates,572.36,88.6,,,percent of total billed charges,88.6% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,206.72,32,,,percent of total billed charges,32% of total billed charges,516.8,80,,,percent of total billed charges,80% of total billed charges,516.8,80,,,percent of total billed charges,80% of total billed charges,244.9,100,,,Fee Schedule,pays based on EAPG rates,587.86,91,,,percent of total billed charges,91% of total billed charges,210.85,32.64,,,percent of total billed charges,32.64% of total billed charges,206.72,32,,,percent of total billed charges,32% of total billed charges,217.06,33.6,,,percent of total billed charges,33.6% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,206.72,32,,,percent of total billed charges,32% of total billed charges,206.72,32,,,percent of total billed charges,32% of total billed charges,594.32,92,,,percent of total billed charges,92% of total billed charges,206.72,594.32,
CARDIOVERSION ELECTIVE,1000247,CDM,450,RC,92960,HCPCS,Outpatient,,,1044,887.4,,847.73,81.2,,,percent of total billed charges,81.2% of total billed charges,340.76,32.64,,,percent of total billed charges,32.64% of total billed charges,772.56,74,,,percent of total billed charges,74% of total billed charges,772.56,74,,,percent of total billed charges,74% of total billed charges,334.08,32,,,percent of total billed charges,32% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,334.08,32,,,percent of total billed charges,32% of total billed charges,741.24,71,,,percent of total billed charges,71% of total billed charges,741.24,71,,,percent of total billed charges,71% of total billed charges,699.48,67,,,percent of total billed charges,67% of total billed charges,699.48,67,,,percent of total billed charges,67% of total billed charges,741.24,71,,,percent of total billed charges,71% of total billed charges,793.44,76,,,percent of total billed charges,76% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,344.1,32.96,,,percent of total billed charges,32.96% of total billed charges,257.15,105,,,Fee Schedule,pays based on EAPG rates,939.6,90,,,percent of total billed charges,90% of total billed charges,939.6,90,,,percent of total billed charges,90% of total billed charges,244.9,100,,,Fee Schedule,pays based on EAPG rates,924.98,88.6,,,percent of total billed charges,88.6% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,334.08,32,,,percent of total billed charges,32% of total billed charges,835.2,80,,,percent of total billed charges,80% of total billed charges,835.2,80,,,percent of total billed charges,80% of total billed charges,244.9,100,,,Fee Schedule,pays based on EAPG rates,950.04,91,,,percent of total billed charges,91% of total billed charges,340.76,32.64,,,percent of total billed charges,32.64% of total billed charges,334.08,32,,,percent of total billed charges,32% of total billed charges,350.78,33.6,,,percent of total billed charges,33.6% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,334.08,32,,,percent of total billed charges,32% of total billed charges,334.08,32,,,percent of total billed charges,32% of total billed charges,960.48,92,,,percent of total billed charges,92% of total billed charges,244.9,960.48,
HYDRATION THERAPY UP TO 1 HR,1000036,CDM,260,RC,96360,HCPCS,Outpatient,,,154,130.9,,125.05,81.2,,,percent of total billed charges,81.2% of total billed charges,50.27,32.64,,,percent of total billed charges,32.64% of total billed charges,113.96,74,,,percent of total billed charges,74% of total billed charges,113.96,74,,,percent of total billed charges,74% of total billed charges,49.28,32,,,percent of total billed charges,32% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,49.28,32,,,percent of total billed charges,32% of total billed charges,109.34,71,,,percent of total billed charges,71% of total billed charges,109.34,71,,,percent of total billed charges,71% of total billed charges,103.18,67,,,percent of total billed charges,67% of total billed charges,103.18,67,,,percent of total billed charges,67% of total billed charges,109.34,71,,,percent of total billed charges,71% of total billed charges,117.04,76,,,percent of total billed charges,76% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,50.76,32.96,,,percent of total billed charges,32.96% of total billed charges,179.54,105,,,Fee Schedule,pays based on EAPG rates,138.6,90,,,percent of total billed charges,90% of total billed charges,138.6,90,,,percent of total billed charges,90% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,136.44,88.6,,,percent of total billed charges,88.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,49.28,32,,,percent of total billed charges,32% of total billed charges,123.2,80,,,percent of total billed charges,80% of total billed charges,123.2,80,,,percent of total billed charges,80% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,140.14,91,,,percent of total billed charges,91% of total billed charges,50.27,32.64,,,percent of total billed charges,32.64% of total billed charges,49.28,32,,,percent of total billed charges,32% of total billed charges,51.74,33.6,,,percent of total billed charges,33.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,49.28,32,,,percent of total billed charges,32% of total billed charges,49.28,32,,,percent of total billed charges,32% of total billed charges,141.68,92,,,percent of total billed charges,92% of total billed charges,49.28,179.54,
HYDRATION THERAPY EACH ADD HR,1000038,CDM,260,RC,96361,HCPCS,Outpatient,,,146,124.1,,118.55,81.2,,,percent of total billed charges,81.2% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,110.96,76,,,percent of total billed charges,76% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,48.12,32.96,,,percent of total billed charges,32.96% of total billed charges,252.92,105,,,Fee Schedule,pays based on EAPG rates,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,240.87,100,,,Fee Schedule,pays based on EAPG rates,129.36,88.6,,,percent of total billed charges,88.6% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,240.87,100,,,Fee Schedule,pays based on EAPG rates,132.86,91,,,percent of total billed charges,91% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,49.06,33.6,,,percent of total billed charges,33.6% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,134.32,92,,,percent of total billed charges,92% of total billed charges,46.72,252.92,
IV THERAPY 1ST HOUR,1000032,CDM,260,RC,96365,HCPCS,Outpatient,,,263,223.55,,213.56,81.2,,,percent of total billed charges,81.2% of total billed charges,85.84,32.64,,,percent of total billed charges,32.64% of total billed charges,194.62,74,,,percent of total billed charges,74% of total billed charges,194.62,74,,,percent of total billed charges,74% of total billed charges,84.16,32,,,percent of total billed charges,32% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,84.16,32,,,percent of total billed charges,32% of total billed charges,186.73,71,,,percent of total billed charges,71% of total billed charges,186.73,71,,,percent of total billed charges,71% of total billed charges,176.21,67,,,percent of total billed charges,67% of total billed charges,176.21,67,,,percent of total billed charges,67% of total billed charges,186.73,71,,,percent of total billed charges,71% of total billed charges,199.88,76,,,percent of total billed charges,76% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,86.68,32.96,,,percent of total billed charges,32.96% of total billed charges,179.54,105,,,Fee Schedule,pays based on EAPG rates,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,233.02,88.6,,,percent of total billed charges,88.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,84.16,32,,,percent of total billed charges,32% of total billed charges,210.4,80,,,percent of total billed charges,80% of total billed charges,210.4,80,,,percent of total billed charges,80% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,239.33,91,,,percent of total billed charges,91% of total billed charges,85.84,32.64,,,percent of total billed charges,32.64% of total billed charges,84.16,32,,,percent of total billed charges,32% of total billed charges,88.37,33.6,,,percent of total billed charges,33.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,84.16,32,,,percent of total billed charges,32% of total billed charges,84.16,32,,,percent of total billed charges,32% of total billed charges,241.96,92,,,percent of total billed charges,92% of total billed charges,84.16,241.96,
IV THERAPY EA ADD HR UP TO 8,1000033,CDM,260,RC,96366,HCPCS,Outpatient,,,146,124.1,,118.55,81.2,,,percent of total billed charges,81.2% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,110.96,76,,,percent of total billed charges,76% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,48.12,32.96,,,percent of total billed charges,32.96% of total billed charges,252.92,105,,,Fee Schedule,pays based on EAPG rates,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,240.87,100,,,Fee Schedule,pays based on EAPG rates,129.36,88.6,,,percent of total billed charges,88.6% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,240.87,100,,,Fee Schedule,pays based on EAPG rates,132.86,91,,,percent of total billed charges,91% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,49.06,33.6,,,percent of total billed charges,33.6% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,134.32,92,,,percent of total billed charges,92% of total billed charges,46.72,252.92,
IV INFU ADD SEQ UP TO 1 HOUR,1000042,CDM,260,RC,96367,HCPCS,Outpatient,,,252,214.2,,204.62,81.2,,,percent of total billed charges,81.2% of total billed charges,82.25,32.64,,,percent of total billed charges,32.64% of total billed charges,186.48,74,,,percent of total billed charges,74% of total billed charges,186.48,74,,,percent of total billed charges,74% of total billed charges,80.64,32,,,percent of total billed charges,32% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,80.64,32,,,percent of total billed charges,32% of total billed charges,178.92,71,,,percent of total billed charges,71% of total billed charges,178.92,71,,,percent of total billed charges,71% of total billed charges,168.84,67,,,percent of total billed charges,67% of total billed charges,168.84,67,,,percent of total billed charges,67% of total billed charges,178.92,71,,,percent of total billed charges,71% of total billed charges,191.52,76,,,percent of total billed charges,76% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,83.06,32.96,,,percent of total billed charges,32.96% of total billed charges,179.54,105,,,Fee Schedule,pays based on EAPG rates,226.8,90,,,percent of total billed charges,90% of total billed charges,226.8,90,,,percent of total billed charges,90% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,223.27,88.6,,,percent of total billed charges,88.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,80.64,32,,,percent of total billed charges,32% of total billed charges,201.6,80,,,percent of total billed charges,80% of total billed charges,201.6,80,,,percent of total billed charges,80% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,229.32,91,,,percent of total billed charges,91% of total billed charges,82.25,32.64,,,percent of total billed charges,32.64% of total billed charges,80.64,32,,,percent of total billed charges,32% of total billed charges,84.67,33.6,,,percent of total billed charges,33.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,80.64,32,,,percent of total billed charges,32% of total billed charges,80.64,32,,,percent of total billed charges,32% of total billed charges,231.84,92,,,percent of total billed charges,92% of total billed charges,80.64,231.84,
IV INFUSION CONCURRENT,1000043,CDM,260,RC,96368,HCPCS,Outpatient,,,256,217.6,,207.87,81.2,,,percent of total billed charges,81.2% of total billed charges,83.56,32.64,,,percent of total billed charges,32.64% of total billed charges,189.44,74,,,percent of total billed charges,74% of total billed charges,189.44,74,,,percent of total billed charges,74% of total billed charges,81.92,32,,,percent of total billed charges,32% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,81.92,32,,,percent of total billed charges,32% of total billed charges,181.76,71,,,percent of total billed charges,71% of total billed charges,181.76,71,,,percent of total billed charges,71% of total billed charges,171.52,67,,,percent of total billed charges,67% of total billed charges,171.52,67,,,percent of total billed charges,67% of total billed charges,181.76,71,,,percent of total billed charges,71% of total billed charges,194.56,76,,,percent of total billed charges,76% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,84.38,32.96,,,percent of total billed charges,32.96% of total billed charges,179.54,105,,,Fee Schedule,pays based on EAPG rates,230.4,90,,,percent of total billed charges,90% of total billed charges,230.4,90,,,percent of total billed charges,90% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,226.82,88.6,,,percent of total billed charges,88.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,81.92,32,,,percent of total billed charges,32% of total billed charges,204.8,80,,,percent of total billed charges,80% of total billed charges,204.8,80,,,percent of total billed charges,80% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,232.96,91,,,percent of total billed charges,91% of total billed charges,83.56,32.64,,,percent of total billed charges,32.64% of total billed charges,81.92,32,,,percent of total billed charges,32% of total billed charges,86.02,33.6,,,percent of total billed charges,33.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,81.92,32,,,percent of total billed charges,32% of total billed charges,81.92,32,,,percent of total billed charges,32% of total billed charges,235.52,92,,,percent of total billed charges,92% of total billed charges,81.92,235.52,
INJECTION IM/SUBQ,1000015,CDM,260,RC,96372,HCPCS,Outpatient,,,109,92.65,,88.51,81.2,,,percent of total billed charges,81.2% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,82.84,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,35.93,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,98.1,90,,,percent of total billed charges,90% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,96.57,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,99.19,91,,,percent of total billed charges,91% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,36.62,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,100.28,92,,,percent of total billed charges,92% of total billed charges,28.05,100.28,
INTRA ARTER INJ THER PROPH DIA,1000013,CDM,450,RC,96373,HCPCS,Outpatient,,,107,90.95,,86.88,81.2,,,percent of total billed charges,81.2% of total billed charges,34.92,32.64,,,percent of total billed charges,32.64% of total billed charges,79.18,74,,,percent of total billed charges,74% of total billed charges,79.18,74,,,percent of total billed charges,74% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,71.69,67,,,percent of total billed charges,67% of total billed charges,71.69,67,,,percent of total billed charges,67% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,81.32,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,35.27,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,96.3,90,,,percent of total billed charges,90% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,94.8,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,97.37,91,,,percent of total billed charges,91% of total billed charges,34.92,32.64,,,percent of total billed charges,32.64% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,35.95,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,98.44,92,,,percent of total billed charges,92% of total billed charges,28.05,98.44,
THER PROPH DX INJ IV PUSH 1,1000014,CDM,260,RC,96374,HCPCS,Outpatient,,,109,92.65,,88.51,81.2,,,percent of total billed charges,81.2% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,82.84,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,35.93,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,98.1,90,,,percent of total billed charges,90% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,96.57,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,99.19,91,,,percent of total billed charges,91% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,36.62,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,100.28,92,,,percent of total billed charges,92% of total billed charges,28.05,100.28,
EA ADDIT SEQUENTIAL IV PUSH,1000034,CDM,260,RC,96375,HCPCS,Outpatient,,,117,99.45,,95,81.2,,,percent of total billed charges,81.2% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,88.92,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,38.56,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,105.3,90,,,percent of total billed charges,90% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,103.66,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,106.47,91,,,percent of total billed charges,91% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,39.31,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,107.64,92,,,percent of total billed charges,92% of total billed charges,28.05,107.64,
EA ADDIT SEQUENTIAL IV PUSH SAME DRUG,1000041,CDM,260,RC,96376,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,28.05,101.2,
MOD SED SAME PHY INIT 15 MIN <5YRS,1000479,CDM,370,RC,99151,HCPCS,Outpatient,,,310,263.5,,251.72,81.2,,,percent of total billed charges,81.2% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,235.6,76,,,percent of total billed charges,76% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,102.18,32.96,,,percent of total billed charges,32.96% of total billed charges,129.75,105,,,Fee Schedule,pays based on EAPG rates,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,123.57,100,,,Fee Schedule,pays based on EAPG rates,274.66,88.6,,,percent of total billed charges,88.6% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,123.57,100,,,Fee Schedule,pays based on EAPG rates,282.1,91,,,percent of total billed charges,91% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,104.16,33.6,,,percent of total billed charges,33.6% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,285.2,92,,,percent of total billed charges,92% of total billed charges,99.2,285.2,
MOD SED SAME PHY INIT 15 MIN >5YRS,1000417,CDM,370,RC,99152,HCPCS,Outpatient,,,310,263.5,,251.72,81.2,,,percent of total billed charges,81.2% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,235.6,76,,,percent of total billed charges,76% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,102.18,32.96,,,percent of total billed charges,32.96% of total billed charges,129.75,105,,,Fee Schedule,pays based on EAPG rates,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,123.57,100,,,Fee Schedule,pays based on EAPG rates,274.66,88.6,,,percent of total billed charges,88.6% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,123.57,100,,,Fee Schedule,pays based on EAPG rates,282.1,91,,,percent of total billed charges,91% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,104.16,33.6,,,percent of total billed charges,33.6% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,285.2,92,,,percent of total billed charges,92% of total billed charges,99.2,285.2,
MOD SED SAME PHY ADDTL 15 MIN,1000418,CDM,370,RC,99153,HCPCS,Outpatient,,,206,175.1,,167.27,81.2,,,percent of total billed charges,81.2% of total billed charges,67.24,32.64,,,percent of total billed charges,32.64% of total billed charges,152.44,74,,,percent of total billed charges,74% of total billed charges,152.44,74,,,percent of total billed charges,74% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,138.02,67,,,percent of total billed charges,67% of total billed charges,138.02,67,,,percent of total billed charges,67% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,156.56,76,,,percent of total billed charges,76% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,67.9,32.96,,,percent of total billed charges,32.96% of total billed charges,129.75,105,,,Fee Schedule,pays based on EAPG rates,185.4,90,,,percent of total billed charges,90% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,123.57,100,,,Fee Schedule,pays based on EAPG rates,182.52,88.6,,,percent of total billed charges,88.6% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,123.57,100,,,Fee Schedule,pays based on EAPG rates,187.46,91,,,percent of total billed charges,91% of total billed charges,67.24,32.64,,,percent of total billed charges,32.64% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,69.22,33.6,,,percent of total billed charges,33.6% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,189.52,92,,,percent of total billed charges,92% of total billed charges,65.92,189.52,
MOD SED OTHER PHY INIT 15 MIN >5YRS,1000486,CDM,370,RC,99156,HCPCS,Outpatient,,,310,263.5,,251.72,81.2,,,percent of total billed charges,81.2% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,235.6,76,,,percent of total billed charges,76% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,102.18,32.96,,,percent of total billed charges,32.96% of total billed charges,129.75,105,,,Fee Schedule,pays based on EAPG rates,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,123.57,100,,,Fee Schedule,pays based on EAPG rates,274.66,88.6,,,percent of total billed charges,88.6% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,123.57,100,,,Fee Schedule,pays based on EAPG rates,282.1,91,,,percent of total billed charges,91% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,104.16,33.6,,,percent of total billed charges,33.6% of total billed charges,127.28,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,285.2,92,,,percent of total billed charges,92% of total billed charges,99.2,285.2,
EMERGENCY RM - TRIAGE ONLY,1000237,CDM,450,RC,99281,HCPCS,Outpatient,,,124,105.4,,100.69,81.2,,,percent of total billed charges,81.2% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,94.24,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,40.87,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,109.86,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,112.84,91,,,percent of total billed charges,91% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,41.66,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,114.08,92,,,percent of total billed charges,92% of total billed charges,39.68,114.08,
EMERGENCY RM LEVEL 1,1000003,CDM,450,RC,99281,HCPCS,Outpatient,,,206,175.1,,167.27,81.2,,,percent of total billed charges,81.2% of total billed charges,67.24,32.64,,,percent of total billed charges,32.64% of total billed charges,152.44,74,,,percent of total billed charges,74% of total billed charges,152.44,74,,,percent of total billed charges,74% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,138.02,67,,,percent of total billed charges,67% of total billed charges,138.02,67,,,percent of total billed charges,67% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,156.56,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,67.9,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,185.4,90,,,percent of total billed charges,90% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,182.52,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,187.46,91,,,percent of total billed charges,91% of total billed charges,67.24,32.64,,,percent of total billed charges,32.64% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,69.22,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,189.52,92,,,percent of total billed charges,92% of total billed charges,42.34,189.52,
EMERGENCY RM LEVEL 2,1000004,CDM,450,RC,99282,HCPCS,Outpatient,,,359,305.15,,291.51,81.2,,,percent of total billed charges,81.2% of total billed charges,117.18,32.64,,,percent of total billed charges,32.64% of total billed charges,265.66,74,,,percent of total billed charges,74% of total billed charges,265.66,74,,,percent of total billed charges,74% of total billed charges,114.88,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,114.88,32,,,percent of total billed charges,32% of total billed charges,254.89,71,,,percent of total billed charges,71% of total billed charges,254.89,71,,,percent of total billed charges,71% of total billed charges,240.53,67,,,percent of total billed charges,67% of total billed charges,240.53,67,,,percent of total billed charges,67% of total billed charges,254.89,71,,,percent of total billed charges,71% of total billed charges,272.84,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.33,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,323.1,90,,,percent of total billed charges,90% of total billed charges,323.1,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,318.07,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,114.88,32,,,percent of total billed charges,32% of total billed charges,287.2,80,,,percent of total billed charges,80% of total billed charges,287.2,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,326.69,91,,,percent of total billed charges,91% of total billed charges,117.18,32.64,,,percent of total billed charges,32.64% of total billed charges,114.88,32,,,percent of total billed charges,32% of total billed charges,120.62,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,114.88,32,,,percent of total billed charges,32% of total billed charges,114.88,32,,,percent of total billed charges,32% of total billed charges,330.28,92,,,percent of total billed charges,92% of total billed charges,42.34,330.28,
EMERGENCY RM LEVEL 3,1000005,CDM,450,RC,99283,HCPCS,Outpatient,,,565,480.25,,458.78,81.2,,,percent of total billed charges,81.2% of total billed charges,184.42,32.64,,,percent of total billed charges,32.64% of total billed charges,418.1,74,,,percent of total billed charges,74% of total billed charges,418.1,74,,,percent of total billed charges,74% of total billed charges,180.8,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,180.8,32,,,percent of total billed charges,32% of total billed charges,401.15,71,,,percent of total billed charges,71% of total billed charges,401.15,71,,,percent of total billed charges,71% of total billed charges,378.55,67,,,percent of total billed charges,67% of total billed charges,378.55,67,,,percent of total billed charges,67% of total billed charges,401.15,71,,,percent of total billed charges,71% of total billed charges,429.4,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,186.22,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,508.5,90,,,percent of total billed charges,90% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,500.59,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,180.8,32,,,percent of total billed charges,32% of total billed charges,452,80,,,percent of total billed charges,80% of total billed charges,452,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,514.15,91,,,percent of total billed charges,91% of total billed charges,184.42,32.64,,,percent of total billed charges,32.64% of total billed charges,180.8,32,,,percent of total billed charges,32% of total billed charges,189.84,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,180.8,32,,,percent of total billed charges,32% of total billed charges,180.8,32,,,percent of total billed charges,32% of total billed charges,519.8,92,,,percent of total billed charges,92% of total billed charges,42.34,519.8,
EMERGENCY RM LEVEL 4,1000006,CDM,450,RC,99284,HCPCS,Outpatient,,,865,735.25,,702.38,81.2,,,percent of total billed charges,81.2% of total billed charges,282.34,32.64,,,percent of total billed charges,32.64% of total billed charges,640.1,74,,,percent of total billed charges,74% of total billed charges,640.1,74,,,percent of total billed charges,74% of total billed charges,276.8,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,276.8,32,,,percent of total billed charges,32% of total billed charges,614.15,71,,,percent of total billed charges,71% of total billed charges,614.15,71,,,percent of total billed charges,71% of total billed charges,579.55,67,,,percent of total billed charges,67% of total billed charges,579.55,67,,,percent of total billed charges,67% of total billed charges,614.15,71,,,percent of total billed charges,71% of total billed charges,657.4,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,285.1,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,778.5,90,,,percent of total billed charges,90% of total billed charges,778.5,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,766.39,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,276.8,32,,,percent of total billed charges,32% of total billed charges,692,80,,,percent of total billed charges,80% of total billed charges,692,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,787.15,91,,,percent of total billed charges,91% of total billed charges,282.34,32.64,,,percent of total billed charges,32.64% of total billed charges,276.8,32,,,percent of total billed charges,32% of total billed charges,290.64,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,276.8,32,,,percent of total billed charges,32% of total billed charges,276.8,32,,,percent of total billed charges,32% of total billed charges,795.8,92,,,percent of total billed charges,92% of total billed charges,42.34,795.8,
EMERGENCY RM LEVEL 5,1000007,CDM,450,RC,99285,HCPCS,Outpatient,,,1318,1120.3,,1070.22,81.2,,,percent of total billed charges,81.2% of total billed charges,430.2,32.64,,,percent of total billed charges,32.64% of total billed charges,975.32,74,,,percent of total billed charges,74% of total billed charges,975.32,74,,,percent of total billed charges,74% of total billed charges,421.76,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,421.76,32,,,percent of total billed charges,32% of total billed charges,935.78,71,,,percent of total billed charges,71% of total billed charges,935.78,71,,,percent of total billed charges,71% of total billed charges,883.06,67,,,percent of total billed charges,67% of total billed charges,883.06,67,,,percent of total billed charges,67% of total billed charges,935.78,71,,,percent of total billed charges,71% of total billed charges,1001.68,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,434.41,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,1186.2,90,,,percent of total billed charges,90% of total billed charges,1186.2,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,1167.75,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,421.76,32,,,percent of total billed charges,32% of total billed charges,1054.4,80,,,percent of total billed charges,80% of total billed charges,1054.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,1199.38,91,,,percent of total billed charges,91% of total billed charges,430.2,32.64,,,percent of total billed charges,32.64% of total billed charges,421.76,32,,,percent of total billed charges,32% of total billed charges,442.85,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,421.76,32,,,percent of total billed charges,32% of total billed charges,421.76,32,,,percent of total billed charges,32% of total billed charges,1212.56,92,,,percent of total billed charges,92% of total billed charges,42.34,1212.56,
ER LEVEL 6 CRIT CARE 30 74 MIN,1000010,CDM,450,RC,99291,HCPCS,Outpatient,,,2779,2362.15,,2256.55,81.2,,,percent of total billed charges,81.2% of total billed charges,907.07,32.64,,,percent of total billed charges,32.64% of total billed charges,2056.46,74,,,percent of total billed charges,74% of total billed charges,2056.46,74,,,percent of total billed charges,74% of total billed charges,889.28,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,889.28,32,,,percent of total billed charges,32% of total billed charges,1973.09,71,,,percent of total billed charges,71% of total billed charges,1973.09,71,,,percent of total billed charges,71% of total billed charges,1861.93,67,,,percent of total billed charges,67% of total billed charges,1861.93,67,,,percent of total billed charges,67% of total billed charges,1973.09,71,,,percent of total billed charges,71% of total billed charges,2112.04,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,915.96,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,2501.1,90,,,percent of total billed charges,90% of total billed charges,2501.1,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,2462.19,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,889.28,32,,,percent of total billed charges,32% of total billed charges,2223.2,80,,,percent of total billed charges,80% of total billed charges,2223.2,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,2528.89,91,,,percent of total billed charges,91% of total billed charges,907.07,32.64,,,percent of total billed charges,32.64% of total billed charges,889.28,32,,,percent of total billed charges,32% of total billed charges,933.74,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,889.28,32,,,percent of total billed charges,32% of total billed charges,889.28,32,,,percent of total billed charges,32% of total billed charges,2556.68,92,,,percent of total billed charges,92% of total billed charges,42.34,2556.68,
ER LEVEL 6 EA ADDIT 30 MIN,1000008,CDM,450,RC,99292,HCPCS,Outpatient,,,516,438.6,,418.99,81.2,,,percent of total billed charges,81.2% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,381.84,74,,,percent of total billed charges,74% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,345.72,67,,,percent of total billed charges,67% of total billed charges,366.36,71,,,percent of total billed charges,71% of total billed charges,392.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,170.07,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,464.4,90,,,percent of total billed charges,90% of total billed charges,464.4,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,457.18,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,412.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,469.56,91,,,percent of total billed charges,91% of total billed charges,168.42,32.64,,,percent of total billed charges,32.64% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,173.38,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,165.12,32,,,percent of total billed charges,32% of total billed charges,165.12,32,,,percent of total billed charges,32% of total billed charges,474.72,92,,,percent of total billed charges,92% of total billed charges,42.34,474.72,
ADMIN COVID VACCINE 1ST DOSE MODERNA,1000431,CDM,771,RC,0011A,HCPCS,Outpatient,,,74,62.9,,60.09,81.2,,,percent of total billed charges,81.2% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,56.24,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,24.39,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,66.6,90,,,percent of total billed charges,90% of total billed charges,66.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,65.56,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,67.34,91,,,percent of total billed charges,91% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,24.86,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,68.08,92,,,percent of total billed charges,92% of total billed charges,23.68,68.08,
ADMIN COVID VACCINE 2ND DOSE MODERNA,1000432,CDM,771,RC,0012A,HCPCS,Outpatient,,,74,62.9,,60.09,81.2,,,percent of total billed charges,81.2% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,56.24,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,24.39,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,66.6,90,,,percent of total billed charges,90% of total billed charges,66.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,65.56,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,67.34,91,,,percent of total billed charges,91% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,24.86,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,68.08,92,,,percent of total billed charges,92% of total billed charges,23.68,68.08,
ADMIN COVID VACCINE BOOSTER MODERNA,1000480,CDM,771,RC,0064A,HCPCS,Outpatient,,,74,62.9,,60.09,81.2,,,percent of total billed charges,81.2% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,56.24,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,24.39,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,66.6,90,,,percent of total billed charges,90% of total billed charges,66.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,65.56,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,67.34,91,,,percent of total billed charges,91% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,24.86,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,68.08,92,,,percent of total billed charges,92% of total billed charges,23.68,68.08,
ADM COVID BOOSTER BIVALENT MODERNA,1000483,CDM,771,RC,0134A,HCPCS,Outpatient,,,74,62.9,,60.09,81.2,,,percent of total billed charges,81.2% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,56.24,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,24.39,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,66.6,90,,,percent of total billed charges,90% of total billed charges,66.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,65.56,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,67.34,91,,,percent of total billed charges,91% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,24.86,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,23.68,32,,,percent of total billed charges,32% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,68.08,92,,,percent of total billed charges,92% of total billed charges,23.68,68.08,
CATH FOR SPECIMEN COLLECTION,1000429,CDM,450,RC,P9612,HCPCS,Outpatient,,,83,70.55,,67.4,81.2,,,percent of total billed charges,81.2% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,63.08,76,,,percent of total billed charges,76% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,27.36,32.96,,,percent of total billed charges,32.96% of total billed charges,1.7,105,,,Fee Schedule,pays based on EAPG rates,74.7,90,,,percent of total billed charges,90% of total billed charges,74.7,90,,,percent of total billed charges,90% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,73.54,88.6,,,percent of total billed charges,88.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,75.53,91,,,percent of total billed charges,91% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,27.89,33.6,,,percent of total billed charges,33.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,76.36,92,,,percent of total billed charges,92% of total billed charges,1.62,76.36,
PICC LINE PLACEMENT,9600031,CDM,761,RC,36569,HCPCS,Outpatient,,,1363,1158.55,,1106.76,81.2,,,percent of total billed charges,81.2% of total billed charges,444.88,32.64,,,percent of total billed charges,32.64% of total billed charges,1008.62,74,,,percent of total billed charges,74% of total billed charges,1008.62,74,,,percent of total billed charges,74% of total billed charges,436.16,32,,,percent of total billed charges,32% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,436.16,32,,,percent of total billed charges,32% of total billed charges,967.73,71,,,percent of total billed charges,71% of total billed charges,967.73,71,,,percent of total billed charges,71% of total billed charges,913.21,67,,,percent of total billed charges,67% of total billed charges,913.21,67,,,percent of total billed charges,67% of total billed charges,967.73,71,,,percent of total billed charges,71% of total billed charges,1035.88,76,,,percent of total billed charges,76% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,449.24,32.96,,,percent of total billed charges,32.96% of total billed charges,497.73,105,,,Fee Schedule,pays based on EAPG rates,1226.7,90,,,percent of total billed charges,90% of total billed charges,1226.7,90,,,percent of total billed charges,90% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,1207.62,88.6,,,percent of total billed charges,88.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,436.16,32,,,percent of total billed charges,32% of total billed charges,1090.4,80,,,percent of total billed charges,80% of total billed charges,1090.4,80,,,percent of total billed charges,80% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,1240.33,91,,,percent of total billed charges,91% of total billed charges,444.88,32.64,,,percent of total billed charges,32.64% of total billed charges,436.16,32,,,percent of total billed charges,32% of total billed charges,457.97,33.6,,,percent of total billed charges,33.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,436.16,32,,,percent of total billed charges,32% of total billed charges,436.16,32,,,percent of total billed charges,32% of total billed charges,1253.96,92,,,percent of total billed charges,92% of total billed charges,436.16,1253.96,
REPLACE NON-TUNNELED CV CATH,9600047,CDM,761,RC,36580,HCPCS,Outpatient,,,4690,3986.5,,3808.28,81.2,,,percent of total billed charges,81.2% of total billed charges,1530.82,32.64,,,percent of total billed charges,32.64% of total billed charges,3470.6,74,,,percent of total billed charges,74% of total billed charges,3470.6,74,,,percent of total billed charges,74% of total billed charges,1500.8,32,,,percent of total billed charges,32% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,1500.8,32,,,percent of total billed charges,32% of total billed charges,3329.9,71,,,percent of total billed charges,71% of total billed charges,3329.9,71,,,percent of total billed charges,71% of total billed charges,3142.3,67,,,percent of total billed charges,67% of total billed charges,3142.3,67,,,percent of total billed charges,67% of total billed charges,3329.9,71,,,percent of total billed charges,71% of total billed charges,3564.4,76,,,percent of total billed charges,76% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,1545.82,32.96,,,percent of total billed charges,32.96% of total billed charges,497.73,105,,,Fee Schedule,pays based on EAPG rates,4221,90,,,percent of total billed charges,90% of total billed charges,4221,90,,,percent of total billed charges,90% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,4155.34,88.6,,,percent of total billed charges,88.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,1500.8,32,,,percent of total billed charges,32% of total billed charges,3752,80,,,percent of total billed charges,80% of total billed charges,3752,80,,,percent of total billed charges,80% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,4267.9,91,,,percent of total billed charges,91% of total billed charges,1530.82,32.64,,,percent of total billed charges,32.64% of total billed charges,1500.8,32,,,percent of total billed charges,32% of total billed charges,1575.84,33.6,,,percent of total billed charges,33.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,1500.8,32,,,percent of total billed charges,32% of total billed charges,1500.8,32,,,percent of total billed charges,32% of total billed charges,4314.8,92,,,percent of total billed charges,92% of total billed charges,474.03,4314.8,
COLLECT BLOOD COMPL IMPLANT VAD,9600035,CDM,510,RC,36591,HCPCS,Outpatient,,,513,436.05,,416.56,81.2,,,percent of total billed charges,81.2% of total billed charges,167.44,32.64,,,percent of total billed charges,32.64% of total billed charges,379.62,74,,,percent of total billed charges,74% of total billed charges,379.62,74,,,percent of total billed charges,74% of total billed charges,164.16,32,,,percent of total billed charges,32% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,164.16,32,,,percent of total billed charges,32% of total billed charges,364.23,71,,,percent of total billed charges,71% of total billed charges,364.23,71,,,percent of total billed charges,71% of total billed charges,343.71,67,,,percent of total billed charges,67% of total billed charges,343.71,67,,,percent of total billed charges,67% of total billed charges,364.23,71,,,percent of total billed charges,71% of total billed charges,389.88,76,,,percent of total billed charges,76% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,169.08,32.96,,,percent of total billed charges,32.96% of total billed charges,23.1,105,,,Fee Schedule,pays based on EAPG rates,461.7,90,,,percent of total billed charges,90% of total billed charges,461.7,90,,,percent of total billed charges,90% of total billed charges,22,100,,,Fee Schedule,pays based on EAPG rates,454.52,88.6,,,percent of total billed charges,88.6% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,164.16,32,,,percent of total billed charges,32% of total billed charges,410.4,80,,,percent of total billed charges,80% of total billed charges,410.4,80,,,percent of total billed charges,80% of total billed charges,22,100,,,Fee Schedule,pays based on EAPG rates,466.83,91,,,percent of total billed charges,91% of total billed charges,167.44,32.64,,,percent of total billed charges,32.64% of total billed charges,164.16,32,,,percent of total billed charges,32% of total billed charges,172.37,33.6,,,percent of total billed charges,33.6% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,164.16,32,,,percent of total billed charges,32% of total billed charges,164.16,32,,,percent of total billed charges,32% of total billed charges,471.96,92,,,percent of total billed charges,92% of total billed charges,22,471.96,
COLLECT BLOOD EXTERNAL VAD,9600033,CDM,761,RC,36592,HCPCS,Outpatient,,,31,26.35,,25.17,81.2,,,percent of total billed charges,81.2% of total billed charges,10.12,32.64,,,percent of total billed charges,32.64% of total billed charges,22.94,74,,,percent of total billed charges,74% of total billed charges,22.94,74,,,percent of total billed charges,74% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,9.92,32,,,percent of total billed charges,32% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,20.77,67,,,percent of total billed charges,67% of total billed charges,20.77,67,,,percent of total billed charges,67% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,23.56,76,,,percent of total billed charges,76% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,10.22,32.96,,,percent of total billed charges,32.96% of total billed charges,23.1,105,,,Fee Schedule,pays based on EAPG rates,27.9,90,,,percent of total billed charges,90% of total billed charges,27.9,90,,,percent of total billed charges,90% of total billed charges,22,100,,,Fee Schedule,pays based on EAPG rates,27.47,88.6,,,percent of total billed charges,88.6% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,9.92,32,,,percent of total billed charges,32% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,22,100,,,Fee Schedule,pays based on EAPG rates,28.21,91,,,percent of total billed charges,91% of total billed charges,10.12,32.64,,,percent of total billed charges,32.64% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,10.42,33.6,,,percent of total billed charges,33.6% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,9.92,32,,,percent of total billed charges,32% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,28.52,92,,,percent of total billed charges,92% of total billed charges,9.92,28.52,
DECLOT VAD THROMBOLYTIC,9600036,CDM,510,RC,36593,HCPCS,Outpatient,,,1458,1239.3,,1183.9,81.2,,,percent of total billed charges,81.2% of total billed charges,475.89,32.64,,,percent of total billed charges,32.64% of total billed charges,1078.92,74,,,percent of total billed charges,74% of total billed charges,1078.92,74,,,percent of total billed charges,74% of total billed charges,466.56,32,,,percent of total billed charges,32% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,466.56,32,,,percent of total billed charges,32% of total billed charges,1035.18,71,,,percent of total billed charges,71% of total billed charges,1035.18,71,,,percent of total billed charges,71% of total billed charges,976.86,67,,,percent of total billed charges,67% of total billed charges,976.86,67,,,percent of total billed charges,67% of total billed charges,1035.18,71,,,percent of total billed charges,71% of total billed charges,1108.08,76,,,percent of total billed charges,76% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,480.56,32.96,,,percent of total billed charges,32.96% of total billed charges,179.54,105,,,Fee Schedule,pays based on EAPG rates,1312.2,90,,,percent of total billed charges,90% of total billed charges,1312.2,90,,,percent of total billed charges,90% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,1291.79,88.6,,,percent of total billed charges,88.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,466.56,32,,,percent of total billed charges,32% of total billed charges,1166.4,80,,,percent of total billed charges,80% of total billed charges,1166.4,80,,,percent of total billed charges,80% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,1326.78,91,,,percent of total billed charges,91% of total billed charges,475.89,32.64,,,percent of total billed charges,32.64% of total billed charges,466.56,32,,,percent of total billed charges,32% of total billed charges,489.89,33.6,,,percent of total billed charges,33.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,466.56,32,,,percent of total billed charges,32% of total billed charges,466.56,32,,,percent of total billed charges,32% of total billed charges,1341.36,92,,,percent of total billed charges,92% of total billed charges,170.99,1341.36,
"BLADDER IRRIG, LAVAGE, INSTALLATION",9600026,CDM,510,RC,51700,HCPCS,Outpatient,,,682,579.7,,553.78,81.2,,,percent of total billed charges,81.2% of total billed charges,222.6,32.64,,,percent of total billed charges,32.64% of total billed charges,504.68,74,,,percent of total billed charges,74% of total billed charges,504.68,74,,,percent of total billed charges,74% of total billed charges,218.24,32,,,percent of total billed charges,32% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,218.24,32,,,percent of total billed charges,32% of total billed charges,484.22,71,,,percent of total billed charges,71% of total billed charges,484.22,71,,,percent of total billed charges,71% of total billed charges,456.94,67,,,percent of total billed charges,67% of total billed charges,456.94,67,,,percent of total billed charges,67% of total billed charges,484.22,71,,,percent of total billed charges,71% of total billed charges,518.32,76,,,percent of total billed charges,76% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,224.79,32.96,,,percent of total billed charges,32.96% of total billed charges,32.13,105,,,Fee Schedule,pays based on EAPG rates,613.8,90,,,percent of total billed charges,90% of total billed charges,613.8,90,,,percent of total billed charges,90% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,604.25,88.6,,,percent of total billed charges,88.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,218.24,32,,,percent of total billed charges,32% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,545.6,80,,,percent of total billed charges,80% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,620.62,91,,,percent of total billed charges,91% of total billed charges,222.6,32.64,,,percent of total billed charges,32.64% of total billed charges,218.24,32,,,percent of total billed charges,32% of total billed charges,229.15,33.6,,,percent of total billed charges,33.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,218.24,32,,,percent of total billed charges,32% of total billed charges,218.24,32,,,percent of total billed charges,32% of total billed charges,627.44,92,,,percent of total billed charges,92% of total billed charges,30.6,627.44,
CATH INSERT NON-INDWELL BLADDER,9600049,CDM,761,RC,51701,HCPCS,Outpatient,,,85,72.25,,69.02,81.2,,,percent of total billed charges,81.2% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,64.6,76,,,percent of total billed charges,76% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,28.02,32.96,,,percent of total billed charges,32.96% of total billed charges,32.13,105,,,Fee Schedule,pays based on EAPG rates,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,75.31,88.6,,,percent of total billed charges,88.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,77.35,91,,,percent of total billed charges,91% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,28.56,33.6,,,percent of total billed charges,33.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,78.2,92,,,percent of total billed charges,92% of total billed charges,27.2,78.2,
CATH INSERT TEMP INDWELL (FOLEY),9600050,CDM,450,RC,51702,HCPCS,Outpatient,,,85,72.25,,69.02,81.2,,,percent of total billed charges,81.2% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,64.6,76,,,percent of total billed charges,76% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,28.02,32.96,,,percent of total billed charges,32.96% of total billed charges,32.13,105,,,Fee Schedule,pays based on EAPG rates,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,75.31,88.6,,,percent of total billed charges,88.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,77.35,91,,,percent of total billed charges,91% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,28.56,33.6,,,percent of total billed charges,33.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,78.2,92,,,percent of total billed charges,92% of total billed charges,27.2,78.2,
BLADDER INSTILLATION ANTINEOPL,9600027,CDM,510,RC,51720,HCPCS,Outpatient,,,829,704.65,,673.15,81.2,,,percent of total billed charges,81.2% of total billed charges,270.59,32.64,,,percent of total billed charges,32.64% of total billed charges,613.46,74,,,percent of total billed charges,74% of total billed charges,613.46,74,,,percent of total billed charges,74% of total billed charges,265.28,32,,,percent of total billed charges,32% of total billed charges,180.69,103,,,Fee Schedule,pays based on EAPG rates,265.28,32,,,percent of total billed charges,32% of total billed charges,588.59,71,,,percent of total billed charges,71% of total billed charges,588.59,71,,,percent of total billed charges,71% of total billed charges,555.43,67,,,percent of total billed charges,67% of total billed charges,555.43,67,,,percent of total billed charges,67% of total billed charges,588.59,71,,,percent of total billed charges,71% of total billed charges,630.04,76,,,percent of total billed charges,76% of total billed charges,180.69,103,,,Fee Schedule,pays based on EAPG rates,273.24,32.96,,,percent of total billed charges,32.96% of total billed charges,184.19,105,,,Fee Schedule,pays based on EAPG rates,746.1,90,,,percent of total billed charges,90% of total billed charges,746.1,90,,,percent of total billed charges,90% of total billed charges,175.42,100,,,Fee Schedule,pays based on EAPG rates,734.49,88.6,,,percent of total billed charges,88.6% of total billed charges,180.69,103,,,Fee Schedule,pays based on EAPG rates,265.28,32,,,percent of total billed charges,32% of total billed charges,663.2,80,,,percent of total billed charges,80% of total billed charges,663.2,80,,,percent of total billed charges,80% of total billed charges,175.42,100,,,Fee Schedule,pays based on EAPG rates,754.39,91,,,percent of total billed charges,91% of total billed charges,270.59,32.64,,,percent of total billed charges,32.64% of total billed charges,265.28,32,,,percent of total billed charges,32% of total billed charges,278.54,33.6,,,percent of total billed charges,33.6% of total billed charges,180.69,103,,,Fee Schedule,pays based on EAPG rates,265.28,32,,,percent of total billed charges,32% of total billed charges,265.28,32,,,percent of total billed charges,32% of total billed charges,762.68,92,,,percent of total billed charges,92% of total billed charges,175.42,762.68,
CYSTOSCOPY,9600030,CDM,510,RC,52000,HCPCS,Outpatient,,,829,704.65,,673.15,81.2,,,percent of total billed charges,81.2% of total billed charges,270.59,32.64,,,percent of total billed charges,32.64% of total billed charges,613.46,74,,,percent of total billed charges,74% of total billed charges,613.46,74,,,percent of total billed charges,74% of total billed charges,265.28,32,,,percent of total billed charges,32% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,265.28,32,,,percent of total billed charges,32% of total billed charges,588.59,71,,,percent of total billed charges,71% of total billed charges,588.59,71,,,percent of total billed charges,71% of total billed charges,555.43,67,,,percent of total billed charges,67% of total billed charges,555.43,67,,,percent of total billed charges,67% of total billed charges,588.59,71,,,percent of total billed charges,71% of total billed charges,630.04,76,,,percent of total billed charges,76% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,273.24,32.96,,,percent of total billed charges,32.96% of total billed charges,689.81,105,,,Fee Schedule,pays based on EAPG rates,746.1,90,,,percent of total billed charges,90% of total billed charges,746.1,90,,,percent of total billed charges,90% of total billed charges,656.96,100,,,Fee Schedule,pays based on EAPG rates,734.49,88.6,,,percent of total billed charges,88.6% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,265.28,32,,,percent of total billed charges,32% of total billed charges,663.2,80,,,percent of total billed charges,80% of total billed charges,663.2,80,,,percent of total billed charges,80% of total billed charges,656.96,100,,,Fee Schedule,pays based on EAPG rates,754.39,91,,,percent of total billed charges,91% of total billed charges,270.59,32.64,,,percent of total billed charges,32.64% of total billed charges,265.28,32,,,percent of total billed charges,32% of total billed charges,278.54,33.6,,,percent of total billed charges,33.6% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,265.28,32,,,percent of total billed charges,32% of total billed charges,265.28,32,,,percent of total billed charges,32% of total billed charges,762.68,92,,,percent of total billed charges,92% of total billed charges,265.28,762.68,
CYSTO W/ CALIBRATION OR DILATION,9600042,CDM,510,RC,52281,HCPCS,Outpatient,,,2743,2331.55,,2227.32,81.2,,,percent of total billed charges,81.2% of total billed charges,895.32,32.64,,,percent of total billed charges,32.64% of total billed charges,2029.82,74,,,percent of total billed charges,74% of total billed charges,2029.82,74,,,percent of total billed charges,74% of total billed charges,877.76,32,,,percent of total billed charges,32% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,877.76,32,,,percent of total billed charges,32% of total billed charges,1947.53,71,,,percent of total billed charges,71% of total billed charges,1947.53,71,,,percent of total billed charges,71% of total billed charges,1837.81,67,,,percent of total billed charges,67% of total billed charges,1837.81,67,,,percent of total billed charges,67% of total billed charges,1947.53,71,,,percent of total billed charges,71% of total billed charges,2084.68,76,,,percent of total billed charges,76% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,904.09,32.96,,,percent of total billed charges,32.96% of total billed charges,689.81,105,,,Fee Schedule,pays based on EAPG rates,2468.7,90,,,percent of total billed charges,90% of total billed charges,2468.7,90,,,percent of total billed charges,90% of total billed charges,656.96,100,,,Fee Schedule,pays based on EAPG rates,2430.3,88.6,,,percent of total billed charges,88.6% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,877.76,32,,,percent of total billed charges,32% of total billed charges,2194.4,80,,,percent of total billed charges,80% of total billed charges,2194.4,80,,,percent of total billed charges,80% of total billed charges,656.96,100,,,Fee Schedule,pays based on EAPG rates,2496.13,91,,,percent of total billed charges,91% of total billed charges,895.32,32.64,,,percent of total billed charges,32.64% of total billed charges,877.76,32,,,percent of total billed charges,32% of total billed charges,921.65,33.6,,,percent of total billed charges,33.6% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,877.76,32,,,percent of total billed charges,32% of total billed charges,877.76,32,,,percent of total billed charges,32% of total billed charges,2523.56,92,,,percent of total billed charges,92% of total billed charges,656.96,2523.56,
CYSTO W/ RMVL STENT OR FB,9600043,CDM,510,RC,52310,HCPCS,Outpatient,,,2743,2331.55,,2227.32,81.2,,,percent of total billed charges,81.2% of total billed charges,895.32,32.64,,,percent of total billed charges,32.64% of total billed charges,2029.82,74,,,percent of total billed charges,74% of total billed charges,2029.82,74,,,percent of total billed charges,74% of total billed charges,877.76,32,,,percent of total billed charges,32% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,877.76,32,,,percent of total billed charges,32% of total billed charges,1947.53,71,,,percent of total billed charges,71% of total billed charges,1947.53,71,,,percent of total billed charges,71% of total billed charges,1837.81,67,,,percent of total billed charges,67% of total billed charges,1837.81,67,,,percent of total billed charges,67% of total billed charges,1947.53,71,,,percent of total billed charges,71% of total billed charges,2084.68,76,,,percent of total billed charges,76% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,904.09,32.96,,,percent of total billed charges,32.96% of total billed charges,689.81,105,,,Fee Schedule,pays based on EAPG rates,2468.7,90,,,percent of total billed charges,90% of total billed charges,2468.7,90,,,percent of total billed charges,90% of total billed charges,656.96,100,,,Fee Schedule,pays based on EAPG rates,2430.3,88.6,,,percent of total billed charges,88.6% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,877.76,32,,,percent of total billed charges,32% of total billed charges,2194.4,80,,,percent of total billed charges,80% of total billed charges,2194.4,80,,,percent of total billed charges,80% of total billed charges,656.96,100,,,Fee Schedule,pays based on EAPG rates,2496.13,91,,,percent of total billed charges,91% of total billed charges,895.32,32.64,,,percent of total billed charges,32.64% of total billed charges,877.76,32,,,percent of total billed charges,32% of total billed charges,921.65,33.6,,,percent of total billed charges,33.6% of total billed charges,676.67,103,,,Fee Schedule,pays based on EAPG rates,877.76,32,,,percent of total billed charges,32% of total billed charges,877.76,32,,,percent of total billed charges,32% of total billed charges,2523.56,92,,,percent of total billed charges,92% of total billed charges,656.96,2523.56,
EYE ARGON LASER TRABECULO LEFT,9600018,CDM,510,RC,65855,HCPCS,Outpatient,,,1940,1649,,1575.28,81.2,,,percent of total billed charges,81.2% of total billed charges,633.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1435.6,74,,,percent of total billed charges,74% of total billed charges,1435.6,74,,,percent of total billed charges,74% of total billed charges,620.8,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,620.8,32,,,percent of total billed charges,32% of total billed charges,1377.4,71,,,percent of total billed charges,71% of total billed charges,1377.4,71,,,percent of total billed charges,71% of total billed charges,1299.8,67,,,percent of total billed charges,67% of total billed charges,1299.8,67,,,percent of total billed charges,67% of total billed charges,1377.4,71,,,percent of total billed charges,71% of total billed charges,1474.4,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,639.42,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1746,90,,,percent of total billed charges,90% of total billed charges,1746,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1718.84,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,620.8,32,,,percent of total billed charges,32% of total billed charges,1552,80,,,percent of total billed charges,80% of total billed charges,1552,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1765.4,91,,,percent of total billed charges,91% of total billed charges,633.22,32.64,,,percent of total billed charges,32.64% of total billed charges,620.8,32,,,percent of total billed charges,32% of total billed charges,651.84,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,620.8,32,,,percent of total billed charges,32% of total billed charges,620.8,32,,,percent of total billed charges,32% of total billed charges,1784.8,92,,,percent of total billed charges,92% of total billed charges,620.8,1784.8,
EYE ARGON LASER TRABECULO RT,9600019,CDM,510,RC,65855,HCPCS,Outpatient,,,1940,1649,,1575.28,81.2,,,percent of total billed charges,81.2% of total billed charges,633.22,32.64,,,percent of total billed charges,32.64% of total billed charges,1435.6,74,,,percent of total billed charges,74% of total billed charges,1435.6,74,,,percent of total billed charges,74% of total billed charges,620.8,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,620.8,32,,,percent of total billed charges,32% of total billed charges,1377.4,71,,,percent of total billed charges,71% of total billed charges,1377.4,71,,,percent of total billed charges,71% of total billed charges,1299.8,67,,,percent of total billed charges,67% of total billed charges,1299.8,67,,,percent of total billed charges,67% of total billed charges,1377.4,71,,,percent of total billed charges,71% of total billed charges,1474.4,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,639.42,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1746,90,,,percent of total billed charges,90% of total billed charges,1746,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1718.84,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,620.8,32,,,percent of total billed charges,32% of total billed charges,1552,80,,,percent of total billed charges,80% of total billed charges,1552,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1765.4,91,,,percent of total billed charges,91% of total billed charges,633.22,32.64,,,percent of total billed charges,32.64% of total billed charges,620.8,32,,,percent of total billed charges,32% of total billed charges,651.84,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,620.8,32,,,percent of total billed charges,32% of total billed charges,620.8,32,,,percent of total billed charges,32% of total billed charges,1784.8,92,,,percent of total billed charges,92% of total billed charges,620.8,1784.8,
EYE LASER IRIDOTOMY Y&A-LT,9600020,CDM,510,RC,66761,HCPCS,Outpatient,,,2005,1704.25,,1628.06,81.2,,,percent of total billed charges,81.2% of total billed charges,654.43,32.64,,,percent of total billed charges,32.64% of total billed charges,1483.7,74,,,percent of total billed charges,74% of total billed charges,1483.7,74,,,percent of total billed charges,74% of total billed charges,641.6,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,641.6,32,,,percent of total billed charges,32% of total billed charges,1423.55,71,,,percent of total billed charges,71% of total billed charges,1423.55,71,,,percent of total billed charges,71% of total billed charges,1343.35,67,,,percent of total billed charges,67% of total billed charges,1343.35,67,,,percent of total billed charges,67% of total billed charges,1423.55,71,,,percent of total billed charges,71% of total billed charges,1523.8,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,660.85,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1804.5,90,,,percent of total billed charges,90% of total billed charges,1804.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1776.43,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,641.6,32,,,percent of total billed charges,32% of total billed charges,1604,80,,,percent of total billed charges,80% of total billed charges,1604,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1824.55,91,,,percent of total billed charges,91% of total billed charges,654.43,32.64,,,percent of total billed charges,32.64% of total billed charges,641.6,32,,,percent of total billed charges,32% of total billed charges,673.68,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,641.6,32,,,percent of total billed charges,32% of total billed charges,641.6,32,,,percent of total billed charges,32% of total billed charges,1844.6,92,,,percent of total billed charges,92% of total billed charges,641.6,1844.6,
EYE LASER IRIDOTOMY Y&A-RIGHT,9600021,CDM,510,RC,66761,HCPCS,Outpatient,,,2005,1704.25,,1628.06,81.2,,,percent of total billed charges,81.2% of total billed charges,654.43,32.64,,,percent of total billed charges,32.64% of total billed charges,1483.7,74,,,percent of total billed charges,74% of total billed charges,1483.7,74,,,percent of total billed charges,74% of total billed charges,641.6,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,641.6,32,,,percent of total billed charges,32% of total billed charges,1423.55,71,,,percent of total billed charges,71% of total billed charges,1423.55,71,,,percent of total billed charges,71% of total billed charges,1343.35,67,,,percent of total billed charges,67% of total billed charges,1343.35,67,,,percent of total billed charges,67% of total billed charges,1423.55,71,,,percent of total billed charges,71% of total billed charges,1523.8,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,660.85,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1804.5,90,,,percent of total billed charges,90% of total billed charges,1804.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1776.43,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,641.6,32,,,percent of total billed charges,32% of total billed charges,1604,80,,,percent of total billed charges,80% of total billed charges,1604,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1824.55,91,,,percent of total billed charges,91% of total billed charges,654.43,32.64,,,percent of total billed charges,32.64% of total billed charges,641.6,32,,,percent of total billed charges,32% of total billed charges,673.68,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,641.6,32,,,percent of total billed charges,32% of total billed charges,641.6,32,,,percent of total billed charges,32% of total billed charges,1844.6,92,,,percent of total billed charges,92% of total billed charges,641.6,1844.6,
EYE LASER IRIDOTOMY-BILATERAL,9600022,CDM,510,RC,66761,HCPCS,Outpatient,,,3009,2557.65,,2443.31,81.2,,,percent of total billed charges,81.2% of total billed charges,982.14,32.64,,,percent of total billed charges,32.64% of total billed charges,2226.66,74,,,percent of total billed charges,74% of total billed charges,2226.66,74,,,percent of total billed charges,74% of total billed charges,962.88,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,962.88,32,,,percent of total billed charges,32% of total billed charges,2136.39,71,,,percent of total billed charges,71% of total billed charges,2136.39,71,,,percent of total billed charges,71% of total billed charges,2016.03,67,,,percent of total billed charges,67% of total billed charges,2016.03,67,,,percent of total billed charges,67% of total billed charges,2136.39,71,,,percent of total billed charges,71% of total billed charges,2286.84,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,991.77,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,2708.1,90,,,percent of total billed charges,90% of total billed charges,2708.1,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,2665.97,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,962.88,32,,,percent of total billed charges,32% of total billed charges,2407.2,80,,,percent of total billed charges,80% of total billed charges,2407.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,2738.19,91,,,percent of total billed charges,91% of total billed charges,982.14,32.64,,,percent of total billed charges,32.64% of total billed charges,962.88,32,,,percent of total billed charges,32% of total billed charges,1011.02,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,962.88,32,,,percent of total billed charges,32% of total billed charges,962.88,32,,,percent of total billed charges,32% of total billed charges,2768.28,92,,,percent of total billed charges,92% of total billed charges,962.88,2768.28,
EYE LASER POST CAPSULO RIGHT,9600024,CDM,510,RC,66821,HCPCS,Outpatient,,,2126,1807.1,,1726.31,81.2,,,percent of total billed charges,81.2% of total billed charges,693.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1573.24,74,,,percent of total billed charges,74% of total billed charges,1573.24,74,,,percent of total billed charges,74% of total billed charges,680.32,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,680.32,32,,,percent of total billed charges,32% of total billed charges,1509.46,71,,,percent of total billed charges,71% of total billed charges,1509.46,71,,,percent of total billed charges,71% of total billed charges,1424.42,67,,,percent of total billed charges,67% of total billed charges,1424.42,67,,,percent of total billed charges,67% of total billed charges,1509.46,71,,,percent of total billed charges,71% of total billed charges,1615.76,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,700.73,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1913.4,90,,,percent of total billed charges,90% of total billed charges,1913.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1883.64,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,680.32,32,,,percent of total billed charges,32% of total billed charges,1700.8,80,,,percent of total billed charges,80% of total billed charges,1700.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1934.66,91,,,percent of total billed charges,91% of total billed charges,693.93,32.64,,,percent of total billed charges,32.64% of total billed charges,680.32,32,,,percent of total billed charges,32% of total billed charges,714.34,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,680.32,32,,,percent of total billed charges,32% of total billed charges,680.32,32,,,percent of total billed charges,32% of total billed charges,1955.92,92,,,percent of total billed charges,92% of total billed charges,680.32,1955.92,
EYE LASER POST CAPSUL YAG-LT,9600023,CDM,510,RC,66821,HCPCS,Outpatient,,,2129,1809.65,,1728.75,81.2,,,percent of total billed charges,81.2% of total billed charges,694.91,32.64,,,percent of total billed charges,32.64% of total billed charges,1575.46,74,,,percent of total billed charges,74% of total billed charges,1575.46,74,,,percent of total billed charges,74% of total billed charges,681.28,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,681.28,32,,,percent of total billed charges,32% of total billed charges,1511.59,71,,,percent of total billed charges,71% of total billed charges,1511.59,71,,,percent of total billed charges,71% of total billed charges,1426.43,67,,,percent of total billed charges,67% of total billed charges,1426.43,67,,,percent of total billed charges,67% of total billed charges,1511.59,71,,,percent of total billed charges,71% of total billed charges,1618.04,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,701.72,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1916.1,90,,,percent of total billed charges,90% of total billed charges,1916.1,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1886.29,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,681.28,32,,,percent of total billed charges,32% of total billed charges,1703.2,80,,,percent of total billed charges,80% of total billed charges,1703.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1937.39,91,,,percent of total billed charges,91% of total billed charges,694.91,32.64,,,percent of total billed charges,32.64% of total billed charges,681.28,32,,,percent of total billed charges,32% of total billed charges,715.34,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,681.28,32,,,percent of total billed charges,32% of total billed charges,681.28,32,,,percent of total billed charges,32% of total billed charges,1958.68,92,,,percent of total billed charges,92% of total billed charges,681.28,1958.68,
EYE LASER POST CAPSULOT BILAT,9600025,CDM,510,RC,66821,HCPCS,Outpatient,,,3195,2715.75,,2594.34,81.2,,,percent of total billed charges,81.2% of total billed charges,1042.85,32.64,,,percent of total billed charges,32.64% of total billed charges,2364.3,74,,,percent of total billed charges,74% of total billed charges,2364.3,74,,,percent of total billed charges,74% of total billed charges,1022.4,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,1022.4,32,,,percent of total billed charges,32% of total billed charges,2268.45,71,,,percent of total billed charges,71% of total billed charges,2268.45,71,,,percent of total billed charges,71% of total billed charges,2140.65,67,,,percent of total billed charges,67% of total billed charges,2140.65,67,,,percent of total billed charges,67% of total billed charges,2268.45,71,,,percent of total billed charges,71% of total billed charges,2428.2,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,1053.07,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,2875.5,90,,,percent of total billed charges,90% of total billed charges,2875.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,2830.77,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,1022.4,32,,,percent of total billed charges,32% of total billed charges,2556,80,,,percent of total billed charges,80% of total billed charges,2556,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,2907.45,91,,,percent of total billed charges,91% of total billed charges,1042.85,32.64,,,percent of total billed charges,32.64% of total billed charges,1022.4,32,,,percent of total billed charges,32% of total billed charges,1073.52,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,1022.4,32,,,percent of total billed charges,32% of total billed charges,1022.4,32,,,percent of total billed charges,32% of total billed charges,2939.4,92,,,percent of total billed charges,92% of total billed charges,1022.4,2939.4,
"CARDIOVERSION, ELECTIVE",9600028,CDM,510,RC,92960,HCPCS,Outpatient,,,923,784.55,,749.48,81.2,,,percent of total billed charges,81.2% of total billed charges,301.27,32.64,,,percent of total billed charges,32.64% of total billed charges,683.02,74,,,percent of total billed charges,74% of total billed charges,683.02,74,,,percent of total billed charges,74% of total billed charges,295.36,32,,,percent of total billed charges,32% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,295.36,32,,,percent of total billed charges,32% of total billed charges,655.33,71,,,percent of total billed charges,71% of total billed charges,655.33,71,,,percent of total billed charges,71% of total billed charges,618.41,67,,,percent of total billed charges,67% of total billed charges,618.41,67,,,percent of total billed charges,67% of total billed charges,655.33,71,,,percent of total billed charges,71% of total billed charges,701.48,76,,,percent of total billed charges,76% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,304.22,32.96,,,percent of total billed charges,32.96% of total billed charges,257.15,105,,,Fee Schedule,pays based on EAPG rates,830.7,90,,,percent of total billed charges,90% of total billed charges,830.7,90,,,percent of total billed charges,90% of total billed charges,244.9,100,,,Fee Schedule,pays based on EAPG rates,817.78,88.6,,,percent of total billed charges,88.6% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,295.36,32,,,percent of total billed charges,32% of total billed charges,738.4,80,,,percent of total billed charges,80% of total billed charges,738.4,80,,,percent of total billed charges,80% of total billed charges,244.9,100,,,Fee Schedule,pays based on EAPG rates,839.93,91,,,percent of total billed charges,91% of total billed charges,301.27,32.64,,,percent of total billed charges,32.64% of total billed charges,295.36,32,,,percent of total billed charges,32% of total billed charges,310.13,33.6,,,percent of total billed charges,33.6% of total billed charges,252.25,103,,,Fee Schedule,pays based on EAPG rates,295.36,32,,,percent of total billed charges,32% of total billed charges,295.36,32,,,percent of total billed charges,32% of total billed charges,849.16,92,,,percent of total billed charges,92% of total billed charges,244.9,849.16,
PORT FLUSH,9600034,CDM,510,RC,96523,HCPCS,Outpatient,,,259,220.15,,210.31,81.2,,,percent of total billed charges,81.2% of total billed charges,84.54,32.64,,,percent of total billed charges,32.64% of total billed charges,191.66,74,,,percent of total billed charges,74% of total billed charges,191.66,74,,,percent of total billed charges,74% of total billed charges,82.88,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,82.88,32,,,percent of total billed charges,32% of total billed charges,183.89,71,,,percent of total billed charges,71% of total billed charges,183.89,71,,,percent of total billed charges,71% of total billed charges,173.53,67,,,percent of total billed charges,67% of total billed charges,173.53,67,,,percent of total billed charges,67% of total billed charges,183.89,71,,,percent of total billed charges,71% of total billed charges,196.84,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,85.37,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,233.1,90,,,percent of total billed charges,90% of total billed charges,233.1,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,229.47,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,82.88,32,,,percent of total billed charges,32% of total billed charges,207.2,80,,,percent of total billed charges,80% of total billed charges,207.2,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,235.69,91,,,percent of total billed charges,91% of total billed charges,84.54,32.64,,,percent of total billed charges,32.64% of total billed charges,82.88,32,,,percent of total billed charges,32% of total billed charges,87.02,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,82.88,32,,,percent of total billed charges,32% of total billed charges,82.88,32,,,percent of total billed charges,32% of total billed charges,238.28,92,,,percent of total billed charges,92% of total billed charges,28.05,238.28,
WOUND DEBRIDEMENT (NON-SELECT),9600037,CDM,510,RC,97602,HCPCS,Outpatient,,,823,699.55,,668.28,81.2,,,percent of total billed charges,81.2% of total billed charges,268.63,32.64,,,percent of total billed charges,32.64% of total billed charges,609.02,74,,,percent of total billed charges,74% of total billed charges,609.02,74,,,percent of total billed charges,74% of total billed charges,263.36,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,263.36,32,,,percent of total billed charges,32% of total billed charges,584.33,71,,,percent of total billed charges,71% of total billed charges,584.33,71,,,percent of total billed charges,71% of total billed charges,551.41,67,,,percent of total billed charges,67% of total billed charges,551.41,67,,,percent of total billed charges,67% of total billed charges,584.33,71,,,percent of total billed charges,71% of total billed charges,625.48,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,271.26,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,740.7,90,,,percent of total billed charges,90% of total billed charges,740.7,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,729.18,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,263.36,32,,,percent of total billed charges,32% of total billed charges,658.4,80,,,percent of total billed charges,80% of total billed charges,658.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,748.93,91,,,percent of total billed charges,91% of total billed charges,268.63,32.64,,,percent of total billed charges,32.64% of total billed charges,263.36,32,,,percent of total billed charges,32% of total billed charges,276.53,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,263.36,32,,,percent of total billed charges,32% of total billed charges,263.36,32,,,percent of total billed charges,32% of total billed charges,757.16,92,,,percent of total billed charges,92% of total billed charges,147.31,757.16,
WOUND THERAPY NEG PRESS 50CM OR<,9600038,CDM,510,RC,97605,HCPCS,Outpatient,,,823,699.55,,668.28,81.2,,,percent of total billed charges,81.2% of total billed charges,268.63,32.64,,,percent of total billed charges,32.64% of total billed charges,609.02,74,,,percent of total billed charges,74% of total billed charges,609.02,74,,,percent of total billed charges,74% of total billed charges,263.36,32,,,percent of total billed charges,32% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,263.36,32,,,percent of total billed charges,32% of total billed charges,584.33,71,,,percent of total billed charges,71% of total billed charges,584.33,71,,,percent of total billed charges,71% of total billed charges,551.41,67,,,percent of total billed charges,67% of total billed charges,551.41,67,,,percent of total billed charges,67% of total billed charges,584.33,71,,,percent of total billed charges,71% of total billed charges,625.48,76,,,percent of total billed charges,76% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,271.26,32.96,,,percent of total billed charges,32.96% of total billed charges,120.47,105,,,Fee Schedule,pays based on EAPG rates,740.7,90,,,percent of total billed charges,90% of total billed charges,740.7,90,,,percent of total billed charges,90% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,729.18,88.6,,,percent of total billed charges,88.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,263.36,32,,,percent of total billed charges,32% of total billed charges,658.4,80,,,percent of total billed charges,80% of total billed charges,658.4,80,,,percent of total billed charges,80% of total billed charges,114.73,100,,,Fee Schedule,pays based on EAPG rates,748.93,91,,,percent of total billed charges,91% of total billed charges,268.63,32.64,,,percent of total billed charges,32.64% of total billed charges,263.36,32,,,percent of total billed charges,32% of total billed charges,276.53,33.6,,,percent of total billed charges,33.6% of total billed charges,118.17,103,,,Fee Schedule,pays based on EAPG rates,263.36,32,,,percent of total billed charges,32% of total billed charges,263.36,32,,,percent of total billed charges,32% of total billed charges,757.16,92,,,percent of total billed charges,92% of total billed charges,114.73,757.16,
IV INJECTION BEBTELOVIMAB,9600046,CDM,260,RC,M0222,HCPCS,Outpatient,,,683,580.55,,554.6,81.2,,,percent of total billed charges,81.2% of total billed charges,222.93,32.64,,,percent of total billed charges,32.64% of total billed charges,505.42,74,,,percent of total billed charges,74% of total billed charges,505.42,74,,,percent of total billed charges,74% of total billed charges,218.56,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,218.56,32,,,percent of total billed charges,32% of total billed charges,484.93,71,,,percent of total billed charges,71% of total billed charges,484.93,71,,,percent of total billed charges,71% of total billed charges,457.61,67,,,percent of total billed charges,67% of total billed charges,457.61,67,,,percent of total billed charges,67% of total billed charges,484.93,71,,,percent of total billed charges,71% of total billed charges,519.08,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,225.12,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,614.7,90,,,percent of total billed charges,90% of total billed charges,614.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,605.14,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,218.56,32,,,percent of total billed charges,32% of total billed charges,546.4,80,,,percent of total billed charges,80% of total billed charges,546.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,621.53,91,,,percent of total billed charges,91% of total billed charges,222.93,32.64,,,percent of total billed charges,32.64% of total billed charges,218.56,32,,,percent of total billed charges,32% of total billed charges,229.49,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,218.56,32,,,percent of total billed charges,32% of total billed charges,218.56,32,,,percent of total billed charges,32% of total billed charges,628.36,92,,,percent of total billed charges,92% of total billed charges,218.56,628.36,
IV INFUSION CASIRIVIMAB AND IMDEVIMAB,9600044,CDM,771,RC,M0243,HCPCS,Outpatient,,,1063,903.55,,863.16,81.2,,,percent of total billed charges,81.2% of total billed charges,346.96,32.64,,,percent of total billed charges,32.64% of total billed charges,786.62,74,,,percent of total billed charges,74% of total billed charges,786.62,74,,,percent of total billed charges,74% of total billed charges,340.16,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,340.16,32,,,percent of total billed charges,32% of total billed charges,754.73,71,,,percent of total billed charges,71% of total billed charges,754.73,71,,,percent of total billed charges,71% of total billed charges,712.21,67,,,percent of total billed charges,67% of total billed charges,712.21,67,,,percent of total billed charges,67% of total billed charges,754.73,71,,,percent of total billed charges,71% of total billed charges,807.88,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,350.36,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,956.7,90,,,percent of total billed charges,90% of total billed charges,956.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,941.82,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,340.16,32,,,percent of total billed charges,32% of total billed charges,850.4,80,,,percent of total billed charges,80% of total billed charges,850.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,967.33,91,,,percent of total billed charges,91% of total billed charges,346.96,32.64,,,percent of total billed charges,32.64% of total billed charges,340.16,32,,,percent of total billed charges,32% of total billed charges,357.17,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,340.16,32,,,percent of total billed charges,32% of total billed charges,340.16,32,,,percent of total billed charges,32% of total billed charges,977.96,92,,,percent of total billed charges,92% of total billed charges,340.16,977.96,
IV INFUSION BAMLANIVIMAB & ETESEVIMAB,9600041,CDM,771,RC,M0245,HCPCS,Outpatient,,,1063,903.55,,863.16,81.2,,,percent of total billed charges,81.2% of total billed charges,346.96,32.64,,,percent of total billed charges,32.64% of total billed charges,786.62,74,,,percent of total billed charges,74% of total billed charges,786.62,74,,,percent of total billed charges,74% of total billed charges,340.16,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,340.16,32,,,percent of total billed charges,32% of total billed charges,754.73,71,,,percent of total billed charges,71% of total billed charges,754.73,71,,,percent of total billed charges,71% of total billed charges,712.21,67,,,percent of total billed charges,67% of total billed charges,712.21,67,,,percent of total billed charges,67% of total billed charges,754.73,71,,,percent of total billed charges,71% of total billed charges,807.88,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,350.36,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,956.7,90,,,percent of total billed charges,90% of total billed charges,956.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,941.82,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,340.16,32,,,percent of total billed charges,32% of total billed charges,850.4,80,,,percent of total billed charges,80% of total billed charges,850.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,967.33,91,,,percent of total billed charges,91% of total billed charges,346.96,32.64,,,percent of total billed charges,32.64% of total billed charges,340.16,32,,,percent of total billed charges,32% of total billed charges,357.17,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,340.16,32,,,percent of total billed charges,32% of total billed charges,340.16,32,,,percent of total billed charges,32% of total billed charges,977.96,92,,,percent of total billed charges,92% of total billed charges,340.16,977.96,
IV INFUSION SOTROVIMAB,9600045,CDM,771,RC,M0247,HCPCS,Outpatient,,,1063,903.55,,863.16,81.2,,,percent of total billed charges,81.2% of total billed charges,346.96,32.64,,,percent of total billed charges,32.64% of total billed charges,786.62,74,,,percent of total billed charges,74% of total billed charges,786.62,74,,,percent of total billed charges,74% of total billed charges,340.16,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,340.16,32,,,percent of total billed charges,32% of total billed charges,754.73,71,,,percent of total billed charges,71% of total billed charges,754.73,71,,,percent of total billed charges,71% of total billed charges,712.21,67,,,percent of total billed charges,67% of total billed charges,712.21,67,,,percent of total billed charges,67% of total billed charges,754.73,71,,,percent of total billed charges,71% of total billed charges,807.88,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,350.36,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,956.7,90,,,percent of total billed charges,90% of total billed charges,956.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,941.82,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,340.16,32,,,percent of total billed charges,32% of total billed charges,850.4,80,,,percent of total billed charges,80% of total billed charges,850.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,967.33,91,,,percent of total billed charges,91% of total billed charges,346.96,32.64,,,percent of total billed charges,32.64% of total billed charges,340.16,32,,,percent of total billed charges,32% of total billed charges,357.17,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,340.16,32,,,percent of total billed charges,32% of total billed charges,340.16,32,,,percent of total billed charges,32% of total billed charges,977.96,92,,,percent of total billed charges,92% of total billed charges,340.16,977.96,
CATH FOR SPECIMEN COLLECTION,9600048,CDM,761,RC,P9612,HCPCS,Outpatient,,,85,72.25,,69.02,81.2,,,percent of total billed charges,81.2% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,64.6,76,,,percent of total billed charges,76% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,28.02,32.96,,,percent of total billed charges,32.96% of total billed charges,1.7,105,,,Fee Schedule,pays based on EAPG rates,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,75.31,88.6,,,percent of total billed charges,88.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,77.35,91,,,percent of total billed charges,91% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,28.56,33.6,,,percent of total billed charges,33.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,78.2,92,,,percent of total billed charges,92% of total billed charges,1.62,78.2,
VENI PUNCTURE,2000152,CDM,300,RC,36415,HCPCS,Outpatient,,,24,20.4,,19.49,81.2,,,percent of total billed charges,81.2% of total billed charges,7.83,32.64,,,percent of total billed charges,32.64% of total billed charges,17.76,74,,,percent of total billed charges,74% of total billed charges,17.76,74,,,percent of total billed charges,74% of total billed charges,7.68,32,,,percent of total billed charges,32% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,7.68,32,,,percent of total billed charges,32% of total billed charges,17.04,71,,,percent of total billed charges,71% of total billed charges,17.04,71,,,percent of total billed charges,71% of total billed charges,16.08,67,,,percent of total billed charges,67% of total billed charges,16.08,67,,,percent of total billed charges,67% of total billed charges,17.04,71,,,percent of total billed charges,71% of total billed charges,18.24,76,,,percent of total billed charges,76% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,7.91,32.96,,,percent of total billed charges,32.96% of total billed charges,1.7,105,,,Fee Schedule,pays based on EAPG rates,21.6,90,,,percent of total billed charges,90% of total billed charges,21.6,90,,,percent of total billed charges,90% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,21.26,88.6,,,percent of total billed charges,88.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,7.68,32,,,percent of total billed charges,32% of total billed charges,19.2,80,,,percent of total billed charges,80% of total billed charges,19.2,80,,,percent of total billed charges,80% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,21.84,91,,,percent of total billed charges,91% of total billed charges,7.83,32.64,,,percent of total billed charges,32.64% of total billed charges,7.68,32,,,percent of total billed charges,32% of total billed charges,8.06,33.6,,,percent of total billed charges,33.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,7.68,32,,,percent of total billed charges,32% of total billed charges,7.68,32,,,percent of total billed charges,32% of total billed charges,22.08,92,,,percent of total billed charges,92% of total billed charges,1.62,22.08,
VENIPUNCTURE,2099007,CDM,300,RC,36415,HCPCS,Outpatient,,,24,20.4,,19.49,81.2,,,percent of total billed charges,81.2% of total billed charges,7.83,32.64,,,percent of total billed charges,32.64% of total billed charges,17.76,74,,,percent of total billed charges,74% of total billed charges,17.76,74,,,percent of total billed charges,74% of total billed charges,7.68,32,,,percent of total billed charges,32% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,7.68,32,,,percent of total billed charges,32% of total billed charges,17.04,71,,,percent of total billed charges,71% of total billed charges,17.04,71,,,percent of total billed charges,71% of total billed charges,16.08,67,,,percent of total billed charges,67% of total billed charges,16.08,67,,,percent of total billed charges,67% of total billed charges,17.04,71,,,percent of total billed charges,71% of total billed charges,18.24,76,,,percent of total billed charges,76% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,7.91,32.96,,,percent of total billed charges,32.96% of total billed charges,1.7,105,,,Fee Schedule,pays based on EAPG rates,21.6,90,,,percent of total billed charges,90% of total billed charges,21.6,90,,,percent of total billed charges,90% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,21.26,88.6,,,percent of total billed charges,88.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,7.68,32,,,percent of total billed charges,32% of total billed charges,19.2,80,,,percent of total billed charges,80% of total billed charges,19.2,80,,,percent of total billed charges,80% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,21.84,91,,,percent of total billed charges,91% of total billed charges,7.83,32.64,,,percent of total billed charges,32.64% of total billed charges,7.68,32,,,percent of total billed charges,32% of total billed charges,8.06,33.6,,,percent of total billed charges,33.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,7.68,32,,,percent of total billed charges,32% of total billed charges,7.68,32,,,percent of total billed charges,32% of total billed charges,22.08,92,,,percent of total billed charges,92% of total billed charges,1.62,22.08,
CAPILLARY PUNCTURE HEEL/FINGE,2000876,CDM,300,RC,36416,HCPCS,Outpatient,,,36,30.6,,29.23,81.2,,,percent of total billed charges,81.2% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,27.36,76,,,percent of total billed charges,76% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,11.87,32.96,,,percent of total billed charges,32.96% of total billed charges,1.7,105,,,Fee Schedule,pays based on EAPG rates,32.4,90,,,percent of total billed charges,90% of total billed charges,32.4,90,,,percent of total billed charges,90% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,31.9,88.6,,,percent of total billed charges,88.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,32.76,91,,,percent of total billed charges,91% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,12.1,33.6,,,percent of total billed charges,33.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,33.12,92,,,percent of total billed charges,92% of total billed charges,1.62,33.12,
BASIC METABOLIC PANEL,2000592,CDM,301,RC,80048,HCPCS,Outpatient,,,89,75.65,,72.27,81.2,,,percent of total billed charges,81.2% of total billed charges,29.05,32.64,,,percent of total billed charges,32.64% of total billed charges,65.86,74,,,percent of total billed charges,74% of total billed charges,65.86,74,,,percent of total billed charges,74% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,59.63,67,,,percent of total billed charges,67% of total billed charges,59.63,67,,,percent of total billed charges,67% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,67.64,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,29.33,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,80.1,90,,,percent of total billed charges,90% of total billed charges,80.1,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,78.85,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,71.2,80,,,percent of total billed charges,80% of total billed charges,71.2,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,80.99,91,,,percent of total billed charges,91% of total billed charges,29.05,32.64,,,percent of total billed charges,32.64% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,29.9,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,81.88,92,,,percent of total billed charges,92% of total billed charges,12.11,81.88,
GENERAL HEALTH PANEL,2001389,CDM,300,RC,80050,HCPCS,Outpatient,,,397,337.45,,322.36,81.2,,,percent of total billed charges,81.2% of total billed charges,129.58,32.64,,,percent of total billed charges,32.64% of total billed charges,293.78,74,,,percent of total billed charges,74% of total billed charges,293.78,74,,,percent of total billed charges,74% of total billed charges,127.04,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,127.04,32,,,percent of total billed charges,32% of total billed charges,281.87,71,,,percent of total billed charges,71% of total billed charges,281.87,71,,,percent of total billed charges,71% of total billed charges,265.99,67,,,percent of total billed charges,67% of total billed charges,265.99,67,,,percent of total billed charges,67% of total billed charges,281.87,71,,,percent of total billed charges,71% of total billed charges,301.72,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,130.85,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,357.3,90,,,percent of total billed charges,90% of total billed charges,357.3,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,351.74,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,127.04,32,,,percent of total billed charges,32% of total billed charges,317.6,80,,,percent of total billed charges,80% of total billed charges,317.6,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,361.27,91,,,percent of total billed charges,91% of total billed charges,129.58,32.64,,,percent of total billed charges,32.64% of total billed charges,127.04,32,,,percent of total billed charges,32% of total billed charges,133.39,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,127.04,32,,,percent of total billed charges,32% of total billed charges,127.04,32,,,percent of total billed charges,32% of total billed charges,365.24,92,,,percent of total billed charges,92% of total billed charges,12.11,365.24,
ELECTROLYTE PANEL,2000467,CDM,301,RC,80051,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,12.11,46,
COMPREHENSIVE METABOLIC PANEL,2000591,CDM,301,RC,80053,HCPCS,Outpatient,,,165,140.25,,133.98,81.2,,,percent of total billed charges,81.2% of total billed charges,53.86,32.64,,,percent of total billed charges,32.64% of total billed charges,122.1,74,,,percent of total billed charges,74% of total billed charges,122.1,74,,,percent of total billed charges,74% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,52.8,32,,,percent of total billed charges,32% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,110.55,67,,,percent of total billed charges,67% of total billed charges,110.55,67,,,percent of total billed charges,67% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,125.4,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,54.38,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,148.5,90,,,percent of total billed charges,90% of total billed charges,148.5,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,146.19,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,52.8,32,,,percent of total billed charges,32% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,150.15,91,,,percent of total billed charges,91% of total billed charges,53.86,32.64,,,percent of total billed charges,32.64% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,55.44,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,52.8,32,,,percent of total billed charges,32% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,151.8,92,,,percent of total billed charges,92% of total billed charges,12.11,151.8,
PRENATAL PROFILE,2000257,CDM,301,RC,80055,HCPCS,Outpatient,,,440,374,,357.28,81.2,,,percent of total billed charges,81.2% of total billed charges,143.62,32.64,,,percent of total billed charges,32.64% of total billed charges,325.6,74,,,percent of total billed charges,74% of total billed charges,325.6,74,,,percent of total billed charges,74% of total billed charges,140.8,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,140.8,32,,,percent of total billed charges,32% of total billed charges,312.4,71,,,percent of total billed charges,71% of total billed charges,312.4,71,,,percent of total billed charges,71% of total billed charges,294.8,67,,,percent of total billed charges,67% of total billed charges,294.8,67,,,percent of total billed charges,67% of total billed charges,312.4,71,,,percent of total billed charges,71% of total billed charges,334.4,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,145.02,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,396,90,,,percent of total billed charges,90% of total billed charges,396,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,389.84,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,140.8,32,,,percent of total billed charges,32% of total billed charges,352,80,,,percent of total billed charges,80% of total billed charges,352,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,400.4,91,,,percent of total billed charges,91% of total billed charges,143.62,32.64,,,percent of total billed charges,32.64% of total billed charges,140.8,32,,,percent of total billed charges,32% of total billed charges,147.84,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,140.8,32,,,percent of total billed charges,32% of total billed charges,140.8,32,,,percent of total billed charges,32% of total billed charges,404.8,92,,,percent of total billed charges,92% of total billed charges,12.11,404.8,
LIPID PANEL,2000098,CDM,301,RC,80061,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,12.11,95.68,
RENAL FUNCTION PANEL,2000589,CDM,301,RC,80069,HCPCS,Outpatient,,,85,72.25,,69.02,81.2,,,percent of total billed charges,81.2% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,64.6,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,28.02,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,75.31,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,77.35,91,,,percent of total billed charges,91% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,28.56,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,78.2,92,,,percent of total billed charges,92% of total billed charges,12.11,78.2,
RENAL/HEPATIC COMBO PANEL,2001795,CDM,301,RC,80069,HCPCS,Outpatient,,,85,72.25,,69.02,81.2,,,percent of total billed charges,81.2% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,64.6,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,28.02,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,75.31,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,77.35,91,,,percent of total billed charges,91% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,28.56,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,78.2,92,,,percent of total billed charges,92% of total billed charges,12.11,78.2,
HEPATITIS ACUTE SCREEN,2000436,CDM,301,RC,80074,HCPCS,Outpatient,,,230,195.5,,186.76,81.2,,,percent of total billed charges,81.2% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,174.8,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,75.81,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,203.78,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,209.3,91,,,percent of total billed charges,91% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,77.28,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,211.6,92,,,percent of total billed charges,92% of total billed charges,12.11,211.6,
REFLEX HEPATITIS SCREEN W/HCV,2001376,CDM,301,RC,80074,HCPCS,Outpatient,,,230,195.5,,186.76,81.2,,,percent of total billed charges,81.2% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,174.8,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,75.81,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,203.78,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,209.3,91,,,percent of total billed charges,91% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,77.28,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,211.6,92,,,percent of total billed charges,92% of total billed charges,12.11,211.6,
HEPATIC FUNCTION PANEL,2000590,CDM,301,RC,80076,HCPCS,Outpatient,,,106,90.1,,86.07,81.2,,,percent of total billed charges,81.2% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,80.56,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,34.94,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,93.92,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,96.46,91,,,percent of total billed charges,91% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,35.62,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,97.52,92,,,percent of total billed charges,92% of total billed charges,12.11,97.52,
HEPATIC/RENAL COMBO PANEL,2001794,CDM,301,RC,80076,HCPCS,Outpatient,,,106,90.1,,86.07,81.2,,,percent of total billed charges,81.2% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,80.56,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,34.94,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,93.92,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,96.46,91,,,percent of total billed charges,91% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,35.62,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,97.52,92,,,percent of total billed charges,92% of total billed charges,12.11,97.52,
PRENATAL PROFILE + HIV,2001858,CDM,301,RC,80081,HCPCS,Outpatient,,,554,470.9,,449.85,81.2,,,percent of total billed charges,81.2% of total billed charges,180.83,32.64,,,percent of total billed charges,32.64% of total billed charges,409.96,74,,,percent of total billed charges,74% of total billed charges,409.96,74,,,percent of total billed charges,74% of total billed charges,177.28,32,,,percent of total billed charges,32% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,177.28,32,,,percent of total billed charges,32% of total billed charges,393.34,71,,,percent of total billed charges,71% of total billed charges,393.34,71,,,percent of total billed charges,71% of total billed charges,371.18,67,,,percent of total billed charges,67% of total billed charges,371.18,67,,,percent of total billed charges,67% of total billed charges,393.34,71,,,percent of total billed charges,71% of total billed charges,421.04,76,,,percent of total billed charges,76% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,182.6,32.96,,,percent of total billed charges,32.96% of total billed charges,12.72,105,,,Fee Schedule,pays based on EAPG rates,498.6,90,,,percent of total billed charges,90% of total billed charges,498.6,90,,,percent of total billed charges,90% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,490.84,88.6,,,percent of total billed charges,88.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,177.28,32,,,percent of total billed charges,32% of total billed charges,443.2,80,,,percent of total billed charges,80% of total billed charges,443.2,80,,,percent of total billed charges,80% of total billed charges,12.11,100,,,Fee Schedule,pays based on EAPG rates,504.14,91,,,percent of total billed charges,91% of total billed charges,180.83,32.64,,,percent of total billed charges,32.64% of total billed charges,177.28,32,,,percent of total billed charges,32% of total billed charges,186.14,33.6,,,percent of total billed charges,33.6% of total billed charges,12.48,103,,,Fee Schedule,pays based on EAPG rates,177.28,32,,,percent of total billed charges,32% of total billed charges,177.28,32,,,percent of total billed charges,32% of total billed charges,509.68,92,,,percent of total billed charges,92% of total billed charges,12.11,509.68,
TEGRETOL CARBAMAZEPINE,2000138,CDM,301,RC,80156,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,11.28,74.52,
CARBAMAZEPINE FREE,2000861,CDM,301,RC,80157,HCPCS,Outpatient,,,120,102,,97.44,81.2,,,percent of total billed charges,81.2% of total billed charges,39.17,32.64,,,percent of total billed charges,32.64% of total billed charges,88.8,74,,,percent of total billed charges,74% of total billed charges,88.8,74,,,percent of total billed charges,74% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,80.4,67,,,percent of total billed charges,67% of total billed charges,80.4,67,,,percent of total billed charges,67% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,91.2,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,39.55,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,106.32,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,96,80,,,percent of total billed charges,80% of total billed charges,96,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,109.2,91,,,percent of total billed charges,91% of total billed charges,39.17,32.64,,,percent of total billed charges,32.64% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,40.32,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,110.4,92,,,percent of total billed charges,92% of total billed charges,11.28,110.4,
CYCLOSPORIN LEVEL,2000281,CDM,301,RC,80158,HCPCS,Outpatient,,,113,96.05,,91.76,81.2,,,percent of total billed charges,81.2% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,85.88,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,37.24,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,100.12,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,102.83,91,,,percent of total billed charges,91% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,37.97,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,103.96,92,,,percent of total billed charges,92% of total billed charges,11.28,103.96,
DIGOXIN,2000046,CDM,301,RC,80162,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,11.28,112.24,
DEPAKENE,2000044,CDM,301,RC,80164,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,11.28,91.08,
VALPROIC ACID,2000145,CDM,301,RC,80164,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,11.28,91.08,
EVEROLIMUS,2001380,CDM,301,RC,80169,HCPCS,Outpatient,,,197,167.45,,159.96,81.2,,,percent of total billed charges,81.2% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,149.72,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,64.93,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,174.54,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,179.27,91,,,percent of total billed charges,91% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,66.19,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,181.24,92,,,percent of total billed charges,92% of total billed charges,11.28,181.24,
GENTAMICIN,2000420,CDM,301,RC,80170,HCPCS,Outpatient,,,138,117.3,,112.06,81.2,,,percent of total billed charges,81.2% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,104.88,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,45.48,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,122.27,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,125.58,91,,,percent of total billed charges,91% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,46.37,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,126.96,92,,,percent of total billed charges,92% of total billed charges,11.28,126.96,
GENTAMICIN PEAK,2000337,CDM,301,RC,80170,HCPCS,Outpatient,,,138,117.3,,112.06,81.2,,,percent of total billed charges,81.2% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,104.88,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,45.48,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,122.27,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,125.58,91,,,percent of total billed charges,91% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,46.37,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,126.96,92,,,percent of total billed charges,92% of total billed charges,11.28,126.96,
GENTAMICIN RANDOM,2000522,CDM,301,RC,80170,HCPCS,Outpatient,,,138,117.3,,112.06,81.2,,,percent of total billed charges,81.2% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,104.88,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,45.48,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,122.27,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,125.58,91,,,percent of total billed charges,91% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,46.37,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,126.96,92,,,percent of total billed charges,92% of total billed charges,11.28,126.96,
GENTAMICIN TROUGH,2000065,CDM,301,RC,80170,HCPCS,Outpatient,,,138,117.3,,112.06,81.2,,,percent of total billed charges,81.2% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,104.88,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,45.48,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,122.27,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,125.58,91,,,percent of total billed charges,91% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,46.37,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,126.96,92,,,percent of total billed charges,92% of total billed charges,11.28,126.96,
GABAPENTIN SERUM,2000424,CDM,301,RC,80171,HCPCS,Outpatient,,,177,150.45,,143.72,81.2,,,percent of total billed charges,81.2% of total billed charges,57.77,32.64,,,percent of total billed charges,32.64% of total billed charges,130.98,74,,,percent of total billed charges,74% of total billed charges,130.98,74,,,percent of total billed charges,74% of total billed charges,56.64,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,56.64,32,,,percent of total billed charges,32% of total billed charges,125.67,71,,,percent of total billed charges,71% of total billed charges,125.67,71,,,percent of total billed charges,71% of total billed charges,118.59,67,,,percent of total billed charges,67% of total billed charges,118.59,67,,,percent of total billed charges,67% of total billed charges,125.67,71,,,percent of total billed charges,71% of total billed charges,134.52,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,58.34,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,159.3,90,,,percent of total billed charges,90% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,156.82,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,56.64,32,,,percent of total billed charges,32% of total billed charges,141.6,80,,,percent of total billed charges,80% of total billed charges,141.6,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,161.07,91,,,percent of total billed charges,91% of total billed charges,57.77,32.64,,,percent of total billed charges,32.64% of total billed charges,56.64,32,,,percent of total billed charges,32% of total billed charges,59.47,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,56.64,32,,,percent of total billed charges,32% of total billed charges,56.64,32,,,percent of total billed charges,32% of total billed charges,162.84,92,,,percent of total billed charges,92% of total billed charges,11.28,162.84,
LAMICTAL LTG,2000425,CDM,301,RC,80175,HCPCS,Outpatient,,,167,141.95,,135.6,81.2,,,percent of total billed charges,81.2% of total billed charges,54.51,32.64,,,percent of total billed charges,32.64% of total billed charges,123.58,74,,,percent of total billed charges,74% of total billed charges,123.58,74,,,percent of total billed charges,74% of total billed charges,53.44,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,53.44,32,,,percent of total billed charges,32% of total billed charges,118.57,71,,,percent of total billed charges,71% of total billed charges,118.57,71,,,percent of total billed charges,71% of total billed charges,111.89,67,,,percent of total billed charges,67% of total billed charges,111.89,67,,,percent of total billed charges,67% of total billed charges,118.57,71,,,percent of total billed charges,71% of total billed charges,126.92,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,55.04,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,150.3,90,,,percent of total billed charges,90% of total billed charges,150.3,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,147.96,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,53.44,32,,,percent of total billed charges,32% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,151.97,91,,,percent of total billed charges,91% of total billed charges,54.51,32.64,,,percent of total billed charges,32.64% of total billed charges,53.44,32,,,percent of total billed charges,32% of total billed charges,56.11,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,53.44,32,,,percent of total billed charges,32% of total billed charges,53.44,32,,,percent of total billed charges,32% of total billed charges,153.64,92,,,percent of total billed charges,92% of total billed charges,11.28,153.64,
KEPPRA,2000663,CDM,301,RC,80177,HCPCS,Outpatient,,,171,145.35,,138.85,81.2,,,percent of total billed charges,81.2% of total billed charges,55.81,32.64,,,percent of total billed charges,32.64% of total billed charges,126.54,74,,,percent of total billed charges,74% of total billed charges,126.54,74,,,percent of total billed charges,74% of total billed charges,54.72,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,54.72,32,,,percent of total billed charges,32% of total billed charges,121.41,71,,,percent of total billed charges,71% of total billed charges,121.41,71,,,percent of total billed charges,71% of total billed charges,114.57,67,,,percent of total billed charges,67% of total billed charges,114.57,67,,,percent of total billed charges,67% of total billed charges,121.41,71,,,percent of total billed charges,71% of total billed charges,129.96,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,56.36,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,153.9,90,,,percent of total billed charges,90% of total billed charges,153.9,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,151.51,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,54.72,32,,,percent of total billed charges,32% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,155.61,91,,,percent of total billed charges,91% of total billed charges,55.81,32.64,,,percent of total billed charges,32.64% of total billed charges,54.72,32,,,percent of total billed charges,32% of total billed charges,57.46,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,54.72,32,,,percent of total billed charges,32% of total billed charges,54.72,32,,,percent of total billed charges,32% of total billed charges,157.32,92,,,percent of total billed charges,92% of total billed charges,11.28,157.32,
LITHIUM,2000099,CDM,301,RC,80178,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,11.28,93.84,
TRILEPTAL OXYCARBAZEPIME,2000604,CDM,301,RC,80183,HCPCS,Outpatient,,,139,118.15,,112.87,81.2,,,percent of total billed charges,81.2% of total billed charges,45.37,32.64,,,percent of total billed charges,32.64% of total billed charges,102.86,74,,,percent of total billed charges,74% of total billed charges,102.86,74,,,percent of total billed charges,74% of total billed charges,44.48,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.48,32,,,percent of total billed charges,32% of total billed charges,98.69,71,,,percent of total billed charges,71% of total billed charges,98.69,71,,,percent of total billed charges,71% of total billed charges,93.13,67,,,percent of total billed charges,67% of total billed charges,93.13,67,,,percent of total billed charges,67% of total billed charges,98.69,71,,,percent of total billed charges,71% of total billed charges,105.64,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,45.81,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,125.1,90,,,percent of total billed charges,90% of total billed charges,125.1,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,123.15,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.48,32,,,percent of total billed charges,32% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,126.49,91,,,percent of total billed charges,91% of total billed charges,45.37,32.64,,,percent of total billed charges,32.64% of total billed charges,44.48,32,,,percent of total billed charges,32% of total billed charges,46.7,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,44.48,32,,,percent of total billed charges,32% of total billed charges,44.48,32,,,percent of total billed charges,32% of total billed charges,127.88,92,,,percent of total billed charges,92% of total billed charges,11.28,127.88,
PHENOBARBITAL,2000109,CDM,301,RC,80184,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,11.28,101.2,
"DILANTIN, TOTAL",2000047,CDM,301,RC,80185,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,11.28,101.2,
DILANTIN FREE/TOTAL,2000678,CDM,301,RC,80186,HCPCS,Outpatient,,,56,47.6,,45.47,81.2,,,percent of total billed charges,81.2% of total billed charges,18.28,32.64,,,percent of total billed charges,32.64% of total billed charges,41.44,74,,,percent of total billed charges,74% of total billed charges,41.44,74,,,percent of total billed charges,74% of total billed charges,17.92,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,17.92,32,,,percent of total billed charges,32% of total billed charges,39.76,71,,,percent of total billed charges,71% of total billed charges,39.76,71,,,percent of total billed charges,71% of total billed charges,37.52,67,,,percent of total billed charges,67% of total billed charges,37.52,67,,,percent of total billed charges,67% of total billed charges,39.76,71,,,percent of total billed charges,71% of total billed charges,42.56,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,18.46,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,50.4,90,,,percent of total billed charges,90% of total billed charges,50.4,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,49.62,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,17.92,32,,,percent of total billed charges,32% of total billed charges,44.8,80,,,percent of total billed charges,80% of total billed charges,44.8,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,50.96,91,,,percent of total billed charges,91% of total billed charges,18.28,32.64,,,percent of total billed charges,32.64% of total billed charges,17.92,32,,,percent of total billed charges,32% of total billed charges,18.82,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,17.92,32,,,percent of total billed charges,32% of total billed charges,17.92,32,,,percent of total billed charges,32% of total billed charges,51.52,92,,,percent of total billed charges,92% of total billed charges,11.28,51.52,
RAPUMUNE,2000804,CDM,301,RC,80195,HCPCS,Outpatient,,,197,167.45,,159.96,81.2,,,percent of total billed charges,81.2% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,149.72,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,64.93,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,174.54,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,179.27,91,,,percent of total billed charges,91% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,66.19,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,181.24,92,,,percent of total billed charges,92% of total billed charges,11.28,181.24,
FK506,2000448,CDM,301,RC,80197,HCPCS,Outpatient,,,434,368.9,,352.41,81.2,,,percent of total billed charges,81.2% of total billed charges,141.66,32.64,,,percent of total billed charges,32.64% of total billed charges,321.16,74,,,percent of total billed charges,74% of total billed charges,321.16,74,,,percent of total billed charges,74% of total billed charges,138.88,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,138.88,32,,,percent of total billed charges,32% of total billed charges,308.14,71,,,percent of total billed charges,71% of total billed charges,308.14,71,,,percent of total billed charges,71% of total billed charges,290.78,67,,,percent of total billed charges,67% of total billed charges,290.78,67,,,percent of total billed charges,67% of total billed charges,308.14,71,,,percent of total billed charges,71% of total billed charges,329.84,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,143.05,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,390.6,90,,,percent of total billed charges,90% of total billed charges,390.6,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,384.52,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,138.88,32,,,percent of total billed charges,32% of total billed charges,347.2,80,,,percent of total billed charges,80% of total billed charges,347.2,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,394.94,91,,,percent of total billed charges,91% of total billed charges,141.66,32.64,,,percent of total billed charges,32.64% of total billed charges,138.88,32,,,percent of total billed charges,32% of total billed charges,145.82,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,138.88,32,,,percent of total billed charges,32% of total billed charges,138.88,32,,,percent of total billed charges,32% of total billed charges,399.28,92,,,percent of total billed charges,92% of total billed charges,11.28,399.28,
THEOPHYLLINE,2000010,CDM,301,RC,80198,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,11.28,64.4,
TOBRAMYCIN PEAK,2000350,CDM,301,RC,80200,HCPCS,Outpatient,,,148,125.8,,120.18,81.2,,,percent of total billed charges,81.2% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,112.48,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,48.78,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,133.2,90,,,percent of total billed charges,90% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,131.13,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,134.68,91,,,percent of total billed charges,91% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,49.73,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,136.16,92,,,percent of total billed charges,92% of total billed charges,11.28,136.16,
TOBRAMYCIN TROUGH,2000853,CDM,301,RC,80200,HCPCS,Outpatient,,,148,125.8,,120.18,81.2,,,percent of total billed charges,81.2% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,112.48,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,48.78,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,133.2,90,,,percent of total billed charges,90% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,131.13,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,134.68,91,,,percent of total billed charges,91% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,49.73,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,136.16,92,,,percent of total billed charges,92% of total billed charges,11.28,136.16,
TOPIRAMATE,2000463,CDM,301,RC,80201,HCPCS,Outpatient,,,116,98.6,,94.19,81.2,,,percent of total billed charges,81.2% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,88.16,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,38.23,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,104.4,90,,,percent of total billed charges,90% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,102.78,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,105.56,91,,,percent of total billed charges,91% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,38.98,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,106.72,92,,,percent of total billed charges,92% of total billed charges,11.28,106.72,
VANCOMYCIN,2000455,CDM,301,RC,80202,HCPCS,Outpatient,,,108,91.8,,87.7,81.2,,,percent of total billed charges,81.2% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,82.08,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,35.6,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,95.69,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,98.28,91,,,percent of total billed charges,91% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,36.29,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,99.36,92,,,percent of total billed charges,92% of total billed charges,11.28,99.36,
VANCOMYCIN TROUGH,2000352,CDM,301,RC,80202,HCPCS,Outpatient,,,108,91.8,,87.7,81.2,,,percent of total billed charges,81.2% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,82.08,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,35.6,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,95.69,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,98.28,91,,,percent of total billed charges,91% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,36.29,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,99.36,92,,,percent of total billed charges,92% of total billed charges,11.28,99.36,
APIXABAN,2001710,CDM,300,RC,80299,HCPCS,Outpatient,,,130,110.5,,105.56,81.2,,,percent of total billed charges,81.2% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,98.8,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,42.85,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,117,90,,,percent of total billed charges,90% of total billed charges,117,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,115.18,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,118.3,91,,,percent of total billed charges,91% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,43.68,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,119.6,92,,,percent of total billed charges,92% of total billed charges,11.28,119.6,
CORDARONE,2000267,CDM,301,RC,80299,HCPCS,Outpatient,,,130,110.5,,105.56,81.2,,,percent of total billed charges,81.2% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,98.8,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,42.85,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,117,90,,,percent of total billed charges,90% of total billed charges,117,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,115.18,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,118.3,91,,,percent of total billed charges,91% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,43.68,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,119.6,92,,,percent of total billed charges,92% of total billed charges,11.28,119.6,
HUMIRA / ADALIMUMAB,2001728,CDM,300,RC,80299,HCPCS,Outpatient,,,130,110.5,,105.56,81.2,,,percent of total billed charges,81.2% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,98.8,76,,,percent of total billed charges,76% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,42.85,32.96,,,percent of total billed charges,32.96% of total billed charges,11.84,105,,,Fee Schedule,pays based on EAPG rates,117,90,,,percent of total billed charges,90% of total billed charges,117,90,,,percent of total billed charges,90% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,115.18,88.6,,,percent of total billed charges,88.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,11.28,100,,,Fee Schedule,pays based on EAPG rates,118.3,91,,,percent of total billed charges,91% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,43.68,33.6,,,percent of total billed charges,33.6% of total billed charges,11.61,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,119.6,92,,,percent of total billed charges,92% of total billed charges,11.28,119.6,
BUPRENORPHINE URINE,2001227,CDM,301,RC,80307,HCPCS,Outpatient,,,404,343.4,,328.05,81.2,,,percent of total billed charges,81.2% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,307.04,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,133.16,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,357.94,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,367.64,91,,,percent of total billed charges,91% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,135.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,371.68,92,,,percent of total billed charges,92% of total billed charges,12.85,371.68,
DRUG SCREEN 13 W/CONF WB,2001778,CDM,300,RC,80307,HCPCS,Outpatient,,,404,343.4,,328.05,81.2,,,percent of total billed charges,81.2% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,307.04,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,133.16,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,357.94,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,367.64,91,,,percent of total billed charges,91% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,135.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,371.68,92,,,percent of total billed charges,92% of total billed charges,12.85,371.68,
DRUG SCREEN 16 W/REFLEX WHOLE BLOOD,2001504,CDM,300,RC,80307,HCPCS,Outpatient,,,404,343.4,,328.05,81.2,,,percent of total billed charges,81.2% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,307.04,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,133.16,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,357.94,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,367.64,91,,,percent of total billed charges,91% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,135.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,371.68,92,,,percent of total billed charges,92% of total billed charges,12.85,371.68,
DRUG SCREEN SERUM MULTIPLE,2000049,CDM,301,RC,80307,HCPCS,Outpatient,,,404,343.4,,328.05,81.2,,,percent of total billed charges,81.2% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,307.04,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,133.16,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,357.94,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,367.64,91,,,percent of total billed charges,91% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,135.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,371.68,92,,,percent of total billed charges,92% of total billed charges,12.85,371.68,
DRUGS OF ABUSE 10 SERUM,2001421,CDM,300,RC,80307,HCPCS,Outpatient,,,404,343.4,,328.05,81.2,,,percent of total billed charges,81.2% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,307.04,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,133.16,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,357.94,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,367.64,91,,,percent of total billed charges,91% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,135.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,371.68,92,,,percent of total billed charges,92% of total billed charges,12.85,371.68,
U-CORD 14 PANEL,2001490,CDM,301,RC,80307,HCPCS,Outpatient,,,404,343.4,,328.05,81.2,,,percent of total billed charges,81.2% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,307.04,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,133.16,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,357.94,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,367.64,91,,,percent of total billed charges,91% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,135.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,371.68,92,,,percent of total billed charges,92% of total billed charges,12.85,371.68,
URINE DRUG SCREEN STAT,2000892,CDM,300,RC,80307,HCPCS,Outpatient,,,404,343.4,,328.05,81.2,,,percent of total billed charges,81.2% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,307.04,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,133.16,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,357.94,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,367.64,91,,,percent of total billed charges,91% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,135.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,371.68,92,,,percent of total billed charges,92% of total billed charges,12.85,371.68,
ALCOHOL ETHANOL SERUM,2000008,CDM,301,RC,80320,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,11.18,44.16,
ALCOHOL URINE,2001287,CDM,301,RC,80320,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,11.18,44.16,
PHOSPHATIDYLETHANOL,2001790,CDM,301,RC,80321,HCPCS,Outpatient,,,127,107.95,,103.12,81.2,,,percent of total billed charges,81.2% of total billed charges,41.45,32.64,,,percent of total billed charges,32.64% of total billed charges,93.98,74,,,percent of total billed charges,74% of total billed charges,93.98,74,,,percent of total billed charges,74% of total billed charges,40.64,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.64,32,,,percent of total billed charges,32% of total billed charges,90.17,71,,,percent of total billed charges,71% of total billed charges,90.17,71,,,percent of total billed charges,71% of total billed charges,85.09,67,,,percent of total billed charges,67% of total billed charges,85.09,67,,,percent of total billed charges,67% of total billed charges,90.17,71,,,percent of total billed charges,71% of total billed charges,96.52,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.86,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,114.3,90,,,percent of total billed charges,90% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,112.52,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.64,32,,,percent of total billed charges,32% of total billed charges,101.6,80,,,percent of total billed charges,80% of total billed charges,101.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,115.57,91,,,percent of total billed charges,91% of total billed charges,41.45,32.64,,,percent of total billed charges,32.64% of total billed charges,40.64,32,,,percent of total billed charges,32% of total billed charges,42.67,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.64,32,,,percent of total billed charges,32% of total billed charges,40.64,32,,,percent of total billed charges,32% of total billed charges,116.84,92,,,percent of total billed charges,92% of total billed charges,11.18,116.84,
URINE NICOTINE AND METABOLITE,2000518,CDM,301,RC,80323,HCPCS,Outpatient,,,150,127.5,,121.8,81.2,,,percent of total billed charges,81.2% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,114,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,49.44,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,135,90,,,percent of total billed charges,90% of total billed charges,135,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,132.9,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,136.5,91,,,percent of total billed charges,91% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,50.4,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,138,92,,,percent of total billed charges,92% of total billed charges,11.18,138,
"ADDERAL, URINE",2001266,CDM,301,RC,80324,HCPCS,Outpatient,,,169,143.65,,137.23,81.2,,,percent of total billed charges,81.2% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,128.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,55.7,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,152.1,90,,,percent of total billed charges,90% of total billed charges,152.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,149.73,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,153.79,91,,,percent of total billed charges,91% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,56.78,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,155.48,92,,,percent of total billed charges,92% of total billed charges,11.18,155.48,
"AMPHETAMINES CONFIRMATION, URINE",2001824,CDM,301,RC,80324,HCPCS,Outpatient,,,169,143.65,,137.23,81.2,,,percent of total billed charges,81.2% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,128.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,55.7,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,152.1,90,,,percent of total billed charges,90% of total billed charges,152.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,149.73,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,153.79,91,,,percent of total billed charges,91% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,56.78,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,155.48,92,,,percent of total billed charges,92% of total billed charges,11.18,155.48,
ACETAMINOPHEN,2000002,CDM,301,RC,80329,HCPCS,Outpatient,,,105,89.25,,85.26,81.2,,,percent of total billed charges,81.2% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,79.8,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.61,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,94.5,90,,,percent of total billed charges,90% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,93.03,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,95.55,91,,,percent of total billed charges,91% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,35.28,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,96.6,92,,,percent of total billed charges,92% of total billed charges,11.18,96.6,
SALICYLATE,2000127,CDM,301,RC,80329,HCPCS,Outpatient,,,105,89.25,,85.26,81.2,,,percent of total billed charges,81.2% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,79.8,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.61,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,94.5,90,,,percent of total billed charges,90% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,93.03,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,95.55,91,,,percent of total billed charges,91% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,35.28,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,96.6,92,,,percent of total billed charges,92% of total billed charges,11.18,96.6,
RISPERDAL/RISPERDONE,2000652,CDM,301,RC,80342,HCPCS,Outpatient,,,195,165.75,,158.34,81.2,,,percent of total billed charges,81.2% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,148.2,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,64.27,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,172.77,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,177.45,91,,,percent of total billed charges,91% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,65.52,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,179.4,92,,,percent of total billed charges,92% of total billed charges,11.18,179.4,
ZYPREXA,2000975,CDM,301,RC,80342,HCPCS,Outpatient,,,242,205.7,,196.5,81.2,,,percent of total billed charges,81.2% of total billed charges,78.99,32.64,,,percent of total billed charges,32.64% of total billed charges,179.08,74,,,percent of total billed charges,74% of total billed charges,179.08,74,,,percent of total billed charges,74% of total billed charges,77.44,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,77.44,32,,,percent of total billed charges,32% of total billed charges,171.82,71,,,percent of total billed charges,71% of total billed charges,171.82,71,,,percent of total billed charges,71% of total billed charges,162.14,67,,,percent of total billed charges,67% of total billed charges,162.14,67,,,percent of total billed charges,67% of total billed charges,171.82,71,,,percent of total billed charges,71% of total billed charges,183.92,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,79.76,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,217.8,90,,,percent of total billed charges,90% of total billed charges,217.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,214.41,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,77.44,32,,,percent of total billed charges,32% of total billed charges,193.6,80,,,percent of total billed charges,80% of total billed charges,193.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,220.22,91,,,percent of total billed charges,91% of total billed charges,78.99,32.64,,,percent of total billed charges,32.64% of total billed charges,77.44,32,,,percent of total billed charges,32% of total billed charges,81.31,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,77.44,32,,,percent of total billed charges,32% of total billed charges,77.44,32,,,percent of total billed charges,32% of total billed charges,222.64,92,,,percent of total billed charges,92% of total billed charges,11.18,222.64,
CLONAZEPAM LEVEL URINE,2001755,CDM,301,RC,80346,HCPCS,Outpatient,,,28,23.8,,22.74,81.2,,,percent of total billed charges,81.2% of total billed charges,9.14,32.64,,,percent of total billed charges,32.64% of total billed charges,20.72,74,,,percent of total billed charges,74% of total billed charges,20.72,74,,,percent of total billed charges,74% of total billed charges,8.96,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,8.96,32,,,percent of total billed charges,32% of total billed charges,19.88,71,,,percent of total billed charges,71% of total billed charges,19.88,71,,,percent of total billed charges,71% of total billed charges,18.76,67,,,percent of total billed charges,67% of total billed charges,18.76,67,,,percent of total billed charges,67% of total billed charges,19.88,71,,,percent of total billed charges,71% of total billed charges,21.28,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,9.23,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,25.2,90,,,percent of total billed charges,90% of total billed charges,25.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,24.81,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,8.96,32,,,percent of total billed charges,32% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,22.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,25.48,91,,,percent of total billed charges,91% of total billed charges,9.14,32.64,,,percent of total billed charges,32.64% of total billed charges,8.96,32,,,percent of total billed charges,32% of total billed charges,9.41,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,8.96,32,,,percent of total billed charges,32% of total billed charges,8.96,32,,,percent of total billed charges,32% of total billed charges,25.76,92,,,percent of total billed charges,92% of total billed charges,8.96,25.76,
"METHYLPHENIDATE, URINE",2001282,CDM,301,RC,80360,HCPCS,Outpatient,,,180,153,,146.16,81.2,,,percent of total billed charges,81.2% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,136.8,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,59.33,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,162,90,,,percent of total billed charges,90% of total billed charges,162,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,159.48,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,163.8,91,,,percent of total billed charges,91% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,60.48,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,165.6,92,,,percent of total billed charges,92% of total billed charges,11.18,165.6,
"HYDROCODONE, URINE",2000803,CDM,300,RC,80361,HCPCS,Outpatient,,,157,133.45,,127.48,81.2,,,percent of total billed charges,81.2% of total billed charges,51.24,32.64,,,percent of total billed charges,32.64% of total billed charges,116.18,74,,,percent of total billed charges,74% of total billed charges,116.18,74,,,percent of total billed charges,74% of total billed charges,50.24,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,50.24,32,,,percent of total billed charges,32% of total billed charges,111.47,71,,,percent of total billed charges,71% of total billed charges,111.47,71,,,percent of total billed charges,71% of total billed charges,105.19,67,,,percent of total billed charges,67% of total billed charges,105.19,67,,,percent of total billed charges,67% of total billed charges,111.47,71,,,percent of total billed charges,71% of total billed charges,119.32,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,51.75,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,141.3,90,,,percent of total billed charges,90% of total billed charges,141.3,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,139.1,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,50.24,32,,,percent of total billed charges,32% of total billed charges,125.6,80,,,percent of total billed charges,80% of total billed charges,125.6,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,142.87,91,,,percent of total billed charges,91% of total billed charges,51.24,32.64,,,percent of total billed charges,32.64% of total billed charges,50.24,32,,,percent of total billed charges,32% of total billed charges,52.75,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,50.24,32,,,percent of total billed charges,32% of total billed charges,50.24,32,,,percent of total billed charges,32% of total billed charges,144.44,92,,,percent of total billed charges,92% of total billed charges,12.85,144.44,
OPIATES 1 OR MORE CONFIRMATION URINE,2001178,CDM,301,RC,80361,HCPCS,Outpatient,,,157,133.45,,127.48,81.2,,,percent of total billed charges,81.2% of total billed charges,51.24,32.64,,,percent of total billed charges,32.64% of total billed charges,116.18,74,,,percent of total billed charges,74% of total billed charges,116.18,74,,,percent of total billed charges,74% of total billed charges,50.24,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,50.24,32,,,percent of total billed charges,32% of total billed charges,111.47,71,,,percent of total billed charges,71% of total billed charges,111.47,71,,,percent of total billed charges,71% of total billed charges,105.19,67,,,percent of total billed charges,67% of total billed charges,105.19,67,,,percent of total billed charges,67% of total billed charges,111.47,71,,,percent of total billed charges,71% of total billed charges,119.32,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,51.75,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,141.3,90,,,percent of total billed charges,90% of total billed charges,141.3,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,139.1,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,50.24,32,,,percent of total billed charges,32% of total billed charges,125.6,80,,,percent of total billed charges,80% of total billed charges,125.6,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,142.87,91,,,percent of total billed charges,91% of total billed charges,51.24,32.64,,,percent of total billed charges,32.64% of total billed charges,50.24,32,,,percent of total billed charges,32% of total billed charges,52.75,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,50.24,32,,,percent of total billed charges,32% of total billed charges,50.24,32,,,percent of total billed charges,32% of total billed charges,144.44,92,,,percent of total billed charges,92% of total billed charges,12.85,144.44,
OXYCODONE QUANT URINE,2000827,CDM,300,RC,80365,HCPCS,Outpatient,,,83,70.55,,67.4,81.2,,,percent of total billed charges,81.2% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,63.08,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,27.36,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,74.7,90,,,percent of total billed charges,90% of total billed charges,74.7,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,73.54,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,75.53,91,,,percent of total billed charges,91% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,27.89,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,76.36,92,,,percent of total billed charges,92% of total billed charges,7.24,76.36,
DEXAMETHASONE,2001222,CDM,301,RC,80375,HCPCS,Outpatient,,,137,116.45,,111.24,81.2,,,percent of total billed charges,81.2% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,104.12,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.16,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,121.38,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,124.67,91,,,percent of total billed charges,91% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,46.03,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,126.04,92,,,percent of total billed charges,92% of total billed charges,11.18,126.04,
RIVAROXABAN (XARELTO),2001498,CDM,300,RC,80375,HCPCS,Outpatient,,,137,116.45,,111.24,81.2,,,percent of total billed charges,81.2% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,104.12,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.16,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,121.38,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,124.67,91,,,percent of total billed charges,91% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,46.03,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,126.04,92,,,percent of total billed charges,92% of total billed charges,11.18,126.04,
URINALYSIS AUTOMATED,2001869,CDM,307,RC,81001,HCPCS,Outpatient,,,71,60.35,,57.65,81.2,,,percent of total billed charges,81.2% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,53.96,76,,,percent of total billed charges,76% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,23.4,32.96,,,percent of total billed charges,32.96% of total billed charges,4.12,105,,,Fee Schedule,pays based on EAPG rates,63.9,90,,,percent of total billed charges,90% of total billed charges,63.9,90,,,percent of total billed charges,90% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,62.91,88.6,,,percent of total billed charges,88.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,64.61,91,,,percent of total billed charges,91% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,23.86,33.6,,,percent of total billed charges,33.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,65.32,92,,,percent of total billed charges,92% of total billed charges,3.93,65.32,
"URINALYSIS, W/MICROSCOPY",2000144,CDM,307,RC,81001,HCPCS,Outpatient,,,71,60.35,,57.65,81.2,,,percent of total billed charges,81.2% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,53.96,76,,,percent of total billed charges,76% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,23.4,32.96,,,percent of total billed charges,32.96% of total billed charges,4.12,105,,,Fee Schedule,pays based on EAPG rates,63.9,90,,,percent of total billed charges,90% of total billed charges,63.9,90,,,percent of total billed charges,90% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,62.91,88.6,,,percent of total billed charges,88.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,64.61,91,,,percent of total billed charges,91% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,23.86,33.6,,,percent of total billed charges,33.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,65.32,92,,,percent of total billed charges,92% of total billed charges,3.93,65.32,
DIPSTICK URINE,2000048,CDM,307,RC,81002,HCPCS,Outpatient,,,8,6.8,,6.5,81.2,,,percent of total billed charges,81.2% of total billed charges,2.61,32.64,,,percent of total billed charges,32.64% of total billed charges,5.92,74,,,percent of total billed charges,74% of total billed charges,5.92,74,,,percent of total billed charges,74% of total billed charges,2.56,32,,,percent of total billed charges,32% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,2.56,32,,,percent of total billed charges,32% of total billed charges,5.68,71,,,percent of total billed charges,71% of total billed charges,5.68,71,,,percent of total billed charges,71% of total billed charges,5.36,67,,,percent of total billed charges,67% of total billed charges,5.36,67,,,percent of total billed charges,67% of total billed charges,5.68,71,,,percent of total billed charges,71% of total billed charges,6.08,76,,,percent of total billed charges,76% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,2.64,32.96,,,percent of total billed charges,32.96% of total billed charges,4.12,105,,,Fee Schedule,pays based on EAPG rates,7.2,90,,,percent of total billed charges,90% of total billed charges,7.2,90,,,percent of total billed charges,90% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,7.09,88.6,,,percent of total billed charges,88.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,2.56,32,,,percent of total billed charges,32% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,6.4,80,,,percent of total billed charges,80% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,7.28,91,,,percent of total billed charges,91% of total billed charges,2.61,32.64,,,percent of total billed charges,32.64% of total billed charges,2.56,32,,,percent of total billed charges,32% of total billed charges,2.69,33.6,,,percent of total billed charges,33.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,2.56,32,,,percent of total billed charges,32% of total billed charges,2.56,32,,,percent of total billed charges,32% of total billed charges,7.36,92,,,percent of total billed charges,92% of total billed charges,2.56,7.36,
URINALYSIS NO MICRO,2000434,CDM,307,RC,81003,HCPCS,Outpatient,,,40,34,,32.48,81.2,,,percent of total billed charges,81.2% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,30.4,76,,,percent of total billed charges,76% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,13.18,32.96,,,percent of total billed charges,32.96% of total billed charges,4.12,105,,,Fee Schedule,pays based on EAPG rates,36,90,,,percent of total billed charges,90% of total billed charges,36,90,,,percent of total billed charges,90% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,35.44,88.6,,,percent of total billed charges,88.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,36.4,91,,,percent of total billed charges,91% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,13.44,33.6,,,percent of total billed charges,33.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,36.8,92,,,percent of total billed charges,92% of total billed charges,3.93,36.8,
PREGNANCY URINE,2000117,CDM,307,RC,81025,HCPCS,Outpatient,,,113,96.05,,91.76,81.2,,,percent of total billed charges,81.2% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,85.88,76,,,percent of total billed charges,76% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,37.24,32.96,,,percent of total billed charges,32.96% of total billed charges,4.12,105,,,Fee Schedule,pays based on EAPG rates,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,100.12,88.6,,,percent of total billed charges,88.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,102.83,91,,,percent of total billed charges,91% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,37.97,33.6,,,percent of total billed charges,33.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,103.96,92,,,percent of total billed charges,92% of total billed charges,3.93,103.96,
HPA-1A (PLA1 PLT AG) GENO,2001750,CDM,310,RC,81105,HCPCS,Outpatient,,,597,507.45,,484.76,81.2,,,percent of total billed charges,81.2% of total billed charges,194.86,32.64,,,percent of total billed charges,32.64% of total billed charges,441.78,74,,,percent of total billed charges,74% of total billed charges,441.78,74,,,percent of total billed charges,74% of total billed charges,191.04,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,191.04,32,,,percent of total billed charges,32% of total billed charges,423.87,71,,,percent of total billed charges,71% of total billed charges,423.87,71,,,percent of total billed charges,71% of total billed charges,399.99,67,,,percent of total billed charges,67% of total billed charges,399.99,67,,,percent of total billed charges,67% of total billed charges,423.87,71,,,percent of total billed charges,71% of total billed charges,453.72,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,196.77,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,537.3,90,,,percent of total billed charges,90% of total billed charges,537.3,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,528.94,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,191.04,32,,,percent of total billed charges,32% of total billed charges,477.6,80,,,percent of total billed charges,80% of total billed charges,477.6,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,543.27,91,,,percent of total billed charges,91% of total billed charges,194.86,32.64,,,percent of total billed charges,32.64% of total billed charges,191.04,32,,,percent of total billed charges,32% of total billed charges,200.59,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,191.04,32,,,percent of total billed charges,32% of total billed charges,191.04,32,,,percent of total billed charges,32% of total billed charges,549.24,92,,,percent of total billed charges,92% of total billed charges,51.71,549.24,
OSU HC IDH1 MUTATION ANYLS,2001865,CDM,310,RC,81120,HCPCS,Outpatient,,,1074,912.9,,872.09,81.2,,,percent of total billed charges,81.2% of total billed charges,350.55,32.64,,,percent of total billed charges,32.64% of total billed charges,794.76,74,,,percent of total billed charges,74% of total billed charges,794.76,74,,,percent of total billed charges,74% of total billed charges,343.68,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,343.68,32,,,percent of total billed charges,32% of total billed charges,762.54,71,,,percent of total billed charges,71% of total billed charges,762.54,71,,,percent of total billed charges,71% of total billed charges,719.58,67,,,percent of total billed charges,67% of total billed charges,719.58,67,,,percent of total billed charges,67% of total billed charges,762.54,71,,,percent of total billed charges,71% of total billed charges,816.24,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,353.99,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,966.6,90,,,percent of total billed charges,90% of total billed charges,966.6,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,951.56,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,343.68,32,,,percent of total billed charges,32% of total billed charges,859.2,80,,,percent of total billed charges,80% of total billed charges,859.2,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,977.34,91,,,percent of total billed charges,91% of total billed charges,350.55,32.64,,,percent of total billed charges,32.64% of total billed charges,343.68,32,,,percent of total billed charges,32% of total billed charges,360.86,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,343.68,32,,,percent of total billed charges,32% of total billed charges,343.68,32,,,percent of total billed charges,32% of total billed charges,988.08,92,,,percent of total billed charges,92% of total billed charges,71.76,988.08,
OSU HC IDH2 MUTATION ANYLS,2001866,CDM,310,RC,81121,HCPCS,Outpatient,,,1643,1396.55,,1334.12,81.2,,,percent of total billed charges,81.2% of total billed charges,536.28,32.64,,,percent of total billed charges,32.64% of total billed charges,1215.82,74,,,percent of total billed charges,74% of total billed charges,1215.82,74,,,percent of total billed charges,74% of total billed charges,525.76,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,525.76,32,,,percent of total billed charges,32% of total billed charges,1166.53,71,,,percent of total billed charges,71% of total billed charges,1166.53,71,,,percent of total billed charges,71% of total billed charges,1100.81,67,,,percent of total billed charges,67% of total billed charges,1100.81,67,,,percent of total billed charges,67% of total billed charges,1166.53,71,,,percent of total billed charges,71% of total billed charges,1248.68,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,541.53,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,1478.7,90,,,percent of total billed charges,90% of total billed charges,1478.7,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,1455.7,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,525.76,32,,,percent of total billed charges,32% of total billed charges,1314.4,80,,,percent of total billed charges,80% of total billed charges,1314.4,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,1495.13,91,,,percent of total billed charges,91% of total billed charges,536.28,32.64,,,percent of total billed charges,32.64% of total billed charges,525.76,32,,,percent of total billed charges,32% of total billed charges,552.05,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,525.76,32,,,percent of total billed charges,32% of total billed charges,525.76,32,,,percent of total billed charges,32% of total billed charges,1511.56,92,,,percent of total billed charges,92% of total billed charges,71.76,1511.56,
BCR/ABL1 MAJOR BREAKPOINT (PATHOLOGY),2001798,CDM,310,RC,81206,HCPCS,Outpatient,,,710,603.5,,576.52,81.2,,,percent of total billed charges,81.2% of total billed charges,231.74,32.64,,,percent of total billed charges,32.64% of total billed charges,525.4,74,,,percent of total billed charges,74% of total billed charges,525.4,74,,,percent of total billed charges,74% of total billed charges,227.2,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,227.2,32,,,percent of total billed charges,32% of total billed charges,504.1,71,,,percent of total billed charges,71% of total billed charges,504.1,71,,,percent of total billed charges,71% of total billed charges,475.7,67,,,percent of total billed charges,67% of total billed charges,475.7,67,,,percent of total billed charges,67% of total billed charges,504.1,71,,,percent of total billed charges,71% of total billed charges,539.6,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,234.02,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,639,90,,,percent of total billed charges,90% of total billed charges,639,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,629.06,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,227.2,32,,,percent of total billed charges,32% of total billed charges,568,80,,,percent of total billed charges,80% of total billed charges,568,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,646.1,91,,,percent of total billed charges,91% of total billed charges,231.74,32.64,,,percent of total billed charges,32.64% of total billed charges,227.2,32,,,percent of total billed charges,32% of total billed charges,238.56,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,227.2,32,,,percent of total billed charges,32% of total billed charges,227.2,32,,,percent of total billed charges,32% of total billed charges,653.2,92,,,percent of total billed charges,92% of total billed charges,71.76,653.2,
BCR/ABL1 MINOR BREAKPOINT (PATHOLOGY),2001797,CDM,310,RC,81207,HCPCS,Outpatient,,,626,532.1,,508.31,81.2,,,percent of total billed charges,81.2% of total billed charges,204.33,32.64,,,percent of total billed charges,32.64% of total billed charges,463.24,74,,,percent of total billed charges,74% of total billed charges,463.24,74,,,percent of total billed charges,74% of total billed charges,200.32,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,200.32,32,,,percent of total billed charges,32% of total billed charges,444.46,71,,,percent of total billed charges,71% of total billed charges,444.46,71,,,percent of total billed charges,71% of total billed charges,419.42,67,,,percent of total billed charges,67% of total billed charges,419.42,67,,,percent of total billed charges,67% of total billed charges,444.46,71,,,percent of total billed charges,71% of total billed charges,475.76,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,206.33,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,563.4,90,,,percent of total billed charges,90% of total billed charges,563.4,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,554.64,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,200.32,32,,,percent of total billed charges,32% of total billed charges,500.8,80,,,percent of total billed charges,80% of total billed charges,500.8,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,569.66,91,,,percent of total billed charges,91% of total billed charges,204.33,32.64,,,percent of total billed charges,32.64% of total billed charges,200.32,32,,,percent of total billed charges,32% of total billed charges,210.34,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,200.32,32,,,percent of total billed charges,32% of total billed charges,200.32,32,,,percent of total billed charges,32% of total billed charges,575.92,92,,,percent of total billed charges,92% of total billed charges,71.76,575.92,
CALR MUTATION ANALYSIS,2001845,CDM,310,RC,81219,HCPCS,Outpatient,,,1180,1003,,958.16,81.2,,,percent of total billed charges,81.2% of total billed charges,385.15,32.64,,,percent of total billed charges,32.64% of total billed charges,873.2,74,,,percent of total billed charges,74% of total billed charges,873.2,74,,,percent of total billed charges,74% of total billed charges,377.6,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,377.6,32,,,percent of total billed charges,32% of total billed charges,837.8,71,,,percent of total billed charges,71% of total billed charges,837.8,71,,,percent of total billed charges,71% of total billed charges,790.6,67,,,percent of total billed charges,67% of total billed charges,790.6,67,,,percent of total billed charges,67% of total billed charges,837.8,71,,,percent of total billed charges,71% of total billed charges,896.8,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,388.93,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,1062,90,,,percent of total billed charges,90% of total billed charges,1062,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,1045.48,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,377.6,32,,,percent of total billed charges,32% of total billed charges,944,80,,,percent of total billed charges,80% of total billed charges,944,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,1073.8,91,,,percent of total billed charges,91% of total billed charges,385.15,32.64,,,percent of total billed charges,32.64% of total billed charges,377.6,32,,,percent of total billed charges,32% of total billed charges,396.48,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,377.6,32,,,percent of total billed charges,32% of total billed charges,377.6,32,,,percent of total billed charges,32% of total billed charges,1085.6,92,,,percent of total billed charges,92% of total billed charges,71.76,1085.6,
CYSTIC FIBROSIS PANEL 1,2099048,CDM,300,RC,81220,HCPCS,Outpatient,,,192,163.2,,155.9,81.2,,,percent of total billed charges,81.2% of total billed charges,62.67,32.64,,,percent of total billed charges,32.64% of total billed charges,142.08,74,,,percent of total billed charges,74% of total billed charges,142.08,74,,,percent of total billed charges,74% of total billed charges,61.44,32,,,percent of total billed charges,32% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,61.44,32,,,percent of total billed charges,32% of total billed charges,136.32,71,,,percent of total billed charges,71% of total billed charges,136.32,71,,,percent of total billed charges,71% of total billed charges,128.64,67,,,percent of total billed charges,67% of total billed charges,128.64,67,,,percent of total billed charges,67% of total billed charges,136.32,71,,,percent of total billed charges,71% of total billed charges,145.92,76,,,percent of total billed charges,76% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,63.28,32.96,,,percent of total billed charges,32.96% of total billed charges,70.94,105,,,Fee Schedule,pays based on EAPG rates,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,170.11,88.6,,,percent of total billed charges,88.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,61.44,32,,,percent of total billed charges,32% of total billed charges,153.6,80,,,percent of total billed charges,80% of total billed charges,153.6,80,,,percent of total billed charges,80% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,174.72,91,,,percent of total billed charges,91% of total billed charges,62.67,32.64,,,percent of total billed charges,32.64% of total billed charges,61.44,32,,,percent of total billed charges,32% of total billed charges,64.51,33.6,,,percent of total billed charges,33.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,61.44,32,,,percent of total billed charges,32% of total billed charges,61.44,32,,,percent of total billed charges,32% of total billed charges,176.64,92,,,percent of total billed charges,92% of total billed charges,61.44,176.64,
CYTOCHROME P450 2D6 GENO,2001785,CDM,300,RC,81226,HCPCS,Outpatient,,,1980,1683,,1607.76,81.2,,,percent of total billed charges,81.2% of total billed charges,646.27,32.64,,,percent of total billed charges,32.64% of total billed charges,1465.2,74,,,percent of total billed charges,74% of total billed charges,1465.2,74,,,percent of total billed charges,74% of total billed charges,633.6,32,,,percent of total billed charges,32% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,633.6,32,,,percent of total billed charges,32% of total billed charges,1405.8,71,,,percent of total billed charges,71% of total billed charges,1405.8,71,,,percent of total billed charges,71% of total billed charges,1326.6,67,,,percent of total billed charges,67% of total billed charges,1326.6,67,,,percent of total billed charges,67% of total billed charges,1405.8,71,,,percent of total billed charges,71% of total billed charges,1504.8,76,,,percent of total billed charges,76% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,652.61,32.96,,,percent of total billed charges,32.96% of total billed charges,70.94,105,,,Fee Schedule,pays based on EAPG rates,1782,90,,,percent of total billed charges,90% of total billed charges,1782,90,,,percent of total billed charges,90% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,1754.28,88.6,,,percent of total billed charges,88.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,633.6,32,,,percent of total billed charges,32% of total billed charges,1584,80,,,percent of total billed charges,80% of total billed charges,1584,80,,,percent of total billed charges,80% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,1801.8,91,,,percent of total billed charges,91% of total billed charges,646.27,32.64,,,percent of total billed charges,32.64% of total billed charges,633.6,32,,,percent of total billed charges,32% of total billed charges,665.28,33.6,,,percent of total billed charges,33.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,633.6,32,,,percent of total billed charges,32% of total billed charges,633.6,32,,,percent of total billed charges,32% of total billed charges,1821.6,92,,,percent of total billed charges,92% of total billed charges,67.57,1821.6,
DPD-5 TOXICITY,2001637,CDM,310,RC,81232,HCPCS,Outpatient,,,539,458.15,,437.67,81.2,,,percent of total billed charges,81.2% of total billed charges,175.93,32.64,,,percent of total billed charges,32.64% of total billed charges,398.86,74,,,percent of total billed charges,74% of total billed charges,398.86,74,,,percent of total billed charges,74% of total billed charges,172.48,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,172.48,32,,,percent of total billed charges,32% of total billed charges,382.69,71,,,percent of total billed charges,71% of total billed charges,382.69,71,,,percent of total billed charges,71% of total billed charges,361.13,67,,,percent of total billed charges,67% of total billed charges,361.13,67,,,percent of total billed charges,67% of total billed charges,382.69,71,,,percent of total billed charges,71% of total billed charges,409.64,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,177.65,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,485.1,90,,,percent of total billed charges,90% of total billed charges,485.1,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,477.55,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,172.48,32,,,percent of total billed charges,32% of total billed charges,431.2,80,,,percent of total billed charges,80% of total billed charges,431.2,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,490.49,91,,,percent of total billed charges,91% of total billed charges,175.93,32.64,,,percent of total billed charges,32.64% of total billed charges,172.48,32,,,percent of total billed charges,32% of total billed charges,181.1,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,172.48,32,,,percent of total billed charges,32% of total billed charges,172.48,32,,,percent of total billed charges,32% of total billed charges,495.88,92,,,percent of total billed charges,92% of total billed charges,71.76,495.88,
HEMOCHROMATOSIS PANEL,2000613,CDM,301,RC,81256,HCPCS,Outpatient,,,213,181.05,,172.96,81.2,,,percent of total billed charges,81.2% of total billed charges,69.52,32.64,,,percent of total billed charges,32.64% of total billed charges,157.62,74,,,percent of total billed charges,74% of total billed charges,157.62,74,,,percent of total billed charges,74% of total billed charges,68.16,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,68.16,32,,,percent of total billed charges,32% of total billed charges,151.23,71,,,percent of total billed charges,71% of total billed charges,151.23,71,,,percent of total billed charges,71% of total billed charges,142.71,67,,,percent of total billed charges,67% of total billed charges,142.71,67,,,percent of total billed charges,67% of total billed charges,151.23,71,,,percent of total billed charges,71% of total billed charges,161.88,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,70.2,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,191.7,90,,,percent of total billed charges,90% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,188.72,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,68.16,32,,,percent of total billed charges,32% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,193.83,91,,,percent of total billed charges,91% of total billed charges,69.52,32.64,,,percent of total billed charges,32.64% of total billed charges,68.16,32,,,percent of total billed charges,32% of total billed charges,71.57,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,68.16,32,,,percent of total billed charges,32% of total billed charges,68.16,32,,,percent of total billed charges,32% of total billed charges,195.96,92,,,percent of total billed charges,92% of total billed charges,51.71,195.96,
LAB CORP IGVH SOMATIC HYPERMUTATION,2001859,CDM,310,RC,81263,HCPCS,Outpatient,,,1784,1516.4,,1448.61,81.2,,,percent of total billed charges,81.2% of total billed charges,582.3,32.64,,,percent of total billed charges,32.64% of total billed charges,1320.16,74,,,percent of total billed charges,74% of total billed charges,1320.16,74,,,percent of total billed charges,74% of total billed charges,570.88,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,570.88,32,,,percent of total billed charges,32% of total billed charges,1266.64,71,,,percent of total billed charges,71% of total billed charges,1266.64,71,,,percent of total billed charges,71% of total billed charges,1195.28,67,,,percent of total billed charges,67% of total billed charges,1195.28,67,,,percent of total billed charges,67% of total billed charges,1266.64,71,,,percent of total billed charges,71% of total billed charges,1355.84,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,588.01,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,1605.6,90,,,percent of total billed charges,90% of total billed charges,1605.6,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,1580.62,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,570.88,32,,,percent of total billed charges,32% of total billed charges,1427.2,80,,,percent of total billed charges,80% of total billed charges,1427.2,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,1623.44,91,,,percent of total billed charges,91% of total billed charges,582.3,32.64,,,percent of total billed charges,32.64% of total billed charges,570.88,32,,,percent of total billed charges,32% of total billed charges,599.42,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,570.88,32,,,percent of total billed charges,32% of total billed charges,570.88,32,,,percent of total billed charges,32% of total billed charges,1641.28,92,,,percent of total billed charges,92% of total billed charges,71.76,1641.28,
JAK2 QUALITATIVE,2001847,CDM,310,RC,81270,HCPCS,Outpatient,,,410,348.5,,332.92,81.2,,,percent of total billed charges,81.2% of total billed charges,133.82,32.64,,,percent of total billed charges,32.64% of total billed charges,303.4,74,,,percent of total billed charges,74% of total billed charges,303.4,74,,,percent of total billed charges,74% of total billed charges,131.2,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,131.2,32,,,percent of total billed charges,32% of total billed charges,291.1,71,,,percent of total billed charges,71% of total billed charges,291.1,71,,,percent of total billed charges,71% of total billed charges,274.7,67,,,percent of total billed charges,67% of total billed charges,274.7,67,,,percent of total billed charges,67% of total billed charges,291.1,71,,,percent of total billed charges,71% of total billed charges,311.6,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,135.14,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,369,90,,,percent of total billed charges,90% of total billed charges,369,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,363.26,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,131.2,32,,,percent of total billed charges,32% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,328,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,373.1,91,,,percent of total billed charges,91% of total billed charges,133.82,32.64,,,percent of total billed charges,32.64% of total billed charges,131.2,32,,,percent of total billed charges,32% of total billed charges,137.76,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,131.2,32,,,percent of total billed charges,32% of total billed charges,131.2,32,,,percent of total billed charges,32% of total billed charges,377.2,92,,,percent of total billed charges,92% of total billed charges,51.71,377.2,
HUNTINGTON DX MUTATION,2001317,CDM,301,RC,81271,HCPCS,Outpatient,,,585,497.25,,475.02,81.2,,,percent of total billed charges,81.2% of total billed charges,190.94,32.64,,,percent of total billed charges,32.64% of total billed charges,432.9,74,,,percent of total billed charges,74% of total billed charges,432.9,74,,,percent of total billed charges,74% of total billed charges,187.2,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,187.2,32,,,percent of total billed charges,32% of total billed charges,415.35,71,,,percent of total billed charges,71% of total billed charges,415.35,71,,,percent of total billed charges,71% of total billed charges,391.95,67,,,percent of total billed charges,67% of total billed charges,391.95,67,,,percent of total billed charges,67% of total billed charges,415.35,71,,,percent of total billed charges,71% of total billed charges,444.6,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,192.82,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,526.5,90,,,percent of total billed charges,90% of total billed charges,526.5,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,518.31,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,187.2,32,,,percent of total billed charges,32% of total billed charges,468,80,,,percent of total billed charges,80% of total billed charges,468,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,532.35,91,,,percent of total billed charges,91% of total billed charges,190.94,32.64,,,percent of total billed charges,32.64% of total billed charges,187.2,32,,,percent of total billed charges,32% of total billed charges,196.56,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,187.2,32,,,percent of total billed charges,32% of total billed charges,187.2,32,,,percent of total billed charges,32% of total billed charges,538.2,92,,,percent of total billed charges,92% of total billed charges,51.71,538.2,
OSU HC SO KIT GENE ANYLS D816 VARIANT,2001868,CDM,310,RC,81273,HCPCS,Outpatient,,,966,821.1,,784.39,81.2,,,percent of total billed charges,81.2% of total billed charges,315.3,32.64,,,percent of total billed charges,32.64% of total billed charges,714.84,74,,,percent of total billed charges,74% of total billed charges,714.84,74,,,percent of total billed charges,74% of total billed charges,309.12,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,309.12,32,,,percent of total billed charges,32% of total billed charges,685.86,71,,,percent of total billed charges,71% of total billed charges,685.86,71,,,percent of total billed charges,71% of total billed charges,647.22,67,,,percent of total billed charges,67% of total billed charges,647.22,67,,,percent of total billed charges,67% of total billed charges,685.86,71,,,percent of total billed charges,71% of total billed charges,734.16,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,318.39,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,869.4,90,,,percent of total billed charges,90% of total billed charges,869.4,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,855.88,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,309.12,32,,,percent of total billed charges,32% of total billed charges,772.8,80,,,percent of total billed charges,80% of total billed charges,772.8,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,879.06,91,,,percent of total billed charges,91% of total billed charges,315.3,32.64,,,percent of total billed charges,32.64% of total billed charges,309.12,32,,,percent of total billed charges,32% of total billed charges,324.58,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,309.12,32,,,percent of total billed charges,32% of total billed charges,309.12,32,,,percent of total billed charges,32% of total billed charges,888.72,92,,,percent of total billed charges,92% of total billed charges,71.76,888.72,
JAK2 EXONS 12-15,2001848,CDM,310,RC,81279,HCPCS,Outpatient,,,1103,937.55,,895.64,81.2,,,percent of total billed charges,81.2% of total billed charges,360.02,32.64,,,percent of total billed charges,32.64% of total billed charges,816.22,74,,,percent of total billed charges,74% of total billed charges,816.22,74,,,percent of total billed charges,74% of total billed charges,352.96,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,352.96,32,,,percent of total billed charges,32% of total billed charges,783.13,71,,,percent of total billed charges,71% of total billed charges,783.13,71,,,percent of total billed charges,71% of total billed charges,739.01,67,,,percent of total billed charges,67% of total billed charges,739.01,67,,,percent of total billed charges,67% of total billed charges,783.13,71,,,percent of total billed charges,71% of total billed charges,838.28,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,363.55,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,992.7,90,,,percent of total billed charges,90% of total billed charges,992.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,977.26,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,352.96,32,,,percent of total billed charges,32% of total billed charges,882.4,80,,,percent of total billed charges,80% of total billed charges,882.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1003.73,91,,,percent of total billed charges,91% of total billed charges,360.02,32.64,,,percent of total billed charges,32.64% of total billed charges,352.96,32,,,percent of total billed charges,32% of total billed charges,370.61,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,352.96,32,,,percent of total billed charges,32% of total billed charges,352.96,32,,,percent of total billed charges,32% of total billed charges,1014.76,92,,,percent of total billed charges,92% of total billed charges,352.96,1014.76,
MTHFR MOLECULAR DIAG PANEL,2000746,CDM,300,RC,81291,HCPCS,Outpatient,,,213,181.05,,172.96,81.2,,,percent of total billed charges,81.2% of total billed charges,69.52,32.64,,,percent of total billed charges,32.64% of total billed charges,157.62,74,,,percent of total billed charges,74% of total billed charges,157.62,74,,,percent of total billed charges,74% of total billed charges,68.16,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,68.16,32,,,percent of total billed charges,32% of total billed charges,151.23,71,,,percent of total billed charges,71% of total billed charges,151.23,71,,,percent of total billed charges,71% of total billed charges,142.71,67,,,percent of total billed charges,67% of total billed charges,142.71,67,,,percent of total billed charges,67% of total billed charges,151.23,71,,,percent of total billed charges,71% of total billed charges,161.88,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,70.2,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,191.7,90,,,percent of total billed charges,90% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,188.72,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,68.16,32,,,percent of total billed charges,32% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,193.83,91,,,percent of total billed charges,91% of total billed charges,69.52,32.64,,,percent of total billed charges,32.64% of total billed charges,68.16,32,,,percent of total billed charges,32% of total billed charges,71.57,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,68.16,32,,,percent of total billed charges,32% of total billed charges,68.16,32,,,percent of total billed charges,32% of total billed charges,195.96,92,,,percent of total billed charges,92% of total billed charges,51.71,195.96,
SEPTIN 9 GENE METHYLATION,2001639,CDM,310,RC,81327,HCPCS,Outpatient,,,207,175.95,,168.08,81.2,,,percent of total billed charges,81.2% of total billed charges,67.56,32.64,,,percent of total billed charges,32.64% of total billed charges,153.18,74,,,percent of total billed charges,74% of total billed charges,153.18,74,,,percent of total billed charges,74% of total billed charges,66.24,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,66.24,32,,,percent of total billed charges,32% of total billed charges,146.97,71,,,percent of total billed charges,71% of total billed charges,146.97,71,,,percent of total billed charges,71% of total billed charges,138.69,67,,,percent of total billed charges,67% of total billed charges,138.69,67,,,percent of total billed charges,67% of total billed charges,146.97,71,,,percent of total billed charges,71% of total billed charges,157.32,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,68.23,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,186.3,90,,,percent of total billed charges,90% of total billed charges,186.3,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,183.4,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,66.24,32,,,percent of total billed charges,32% of total billed charges,165.6,80,,,percent of total billed charges,80% of total billed charges,165.6,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,188.37,91,,,percent of total billed charges,91% of total billed charges,67.56,32.64,,,percent of total billed charges,32.64% of total billed charges,66.24,32,,,percent of total billed charges,32% of total billed charges,69.55,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,66.24,32,,,percent of total billed charges,32% of total billed charges,66.24,32,,,percent of total billed charges,32% of total billed charges,190.44,92,,,percent of total billed charges,92% of total billed charges,51.71,190.44,
SMN1 ANALYSIS,2001781,CDM,301,RC,81329,HCPCS,Outpatient,,,602,511.7,,488.82,81.2,,,percent of total billed charges,81.2% of total billed charges,196.49,32.64,,,percent of total billed charges,32.64% of total billed charges,445.48,74,,,percent of total billed charges,74% of total billed charges,445.48,74,,,percent of total billed charges,74% of total billed charges,192.64,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,192.64,32,,,percent of total billed charges,32% of total billed charges,427.42,71,,,percent of total billed charges,71% of total billed charges,427.42,71,,,percent of total billed charges,71% of total billed charges,403.34,67,,,percent of total billed charges,67% of total billed charges,403.34,67,,,percent of total billed charges,67% of total billed charges,427.42,71,,,percent of total billed charges,71% of total billed charges,457.52,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,198.42,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,541.8,90,,,percent of total billed charges,90% of total billed charges,541.8,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,533.37,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,192.64,32,,,percent of total billed charges,32% of total billed charges,481.6,80,,,percent of total billed charges,80% of total billed charges,481.6,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,547.82,91,,,percent of total billed charges,91% of total billed charges,196.49,32.64,,,percent of total billed charges,32.64% of total billed charges,192.64,32,,,percent of total billed charges,32% of total billed charges,202.27,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,192.64,32,,,percent of total billed charges,32% of total billed charges,192.64,32,,,percent of total billed charges,32% of total billed charges,553.84,92,,,percent of total billed charges,92% of total billed charges,51.71,553.84,
MPL MUTATION ANALYSIS,2001844,CDM,310,RC,81338,HCPCS,Outpatient,,,1700,1445,,1380.4,81.2,,,percent of total billed charges,81.2% of total billed charges,554.88,32.64,,,percent of total billed charges,32.64% of total billed charges,1258,74,,,percent of total billed charges,74% of total billed charges,1258,74,,,percent of total billed charges,74% of total billed charges,544,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,544,32,,,percent of total billed charges,32% of total billed charges,1207,71,,,percent of total billed charges,71% of total billed charges,1207,71,,,percent of total billed charges,71% of total billed charges,1139,67,,,percent of total billed charges,67% of total billed charges,1139,67,,,percent of total billed charges,67% of total billed charges,1207,71,,,percent of total billed charges,71% of total billed charges,1292,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,560.32,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1530,90,,,percent of total billed charges,90% of total billed charges,1530,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1506.2,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,544,32,,,percent of total billed charges,32% of total billed charges,1360,80,,,percent of total billed charges,80% of total billed charges,1360,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1547,91,,,percent of total billed charges,91% of total billed charges,554.88,32.64,,,percent of total billed charges,32.64% of total billed charges,544,32,,,percent of total billed charges,32% of total billed charges,571.2,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,544,32,,,percent of total billed charges,32% of total billed charges,544,32,,,percent of total billed charges,32% of total billed charges,1564,92,,,percent of total billed charges,92% of total billed charges,544,1564,
LAB CORP T CELL RECEPT GAMMA,2001864,CDM,310,RC,81342,HCPCS,Outpatient,,,865,735.25,,702.38,81.2,,,percent of total billed charges,81.2% of total billed charges,282.34,32.64,,,percent of total billed charges,32.64% of total billed charges,640.1,74,,,percent of total billed charges,74% of total billed charges,640.1,74,,,percent of total billed charges,74% of total billed charges,276.8,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,276.8,32,,,percent of total billed charges,32% of total billed charges,614.15,71,,,percent of total billed charges,71% of total billed charges,614.15,71,,,percent of total billed charges,71% of total billed charges,579.55,67,,,percent of total billed charges,67% of total billed charges,579.55,67,,,percent of total billed charges,67% of total billed charges,614.15,71,,,percent of total billed charges,71% of total billed charges,657.4,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,285.1,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,778.5,90,,,percent of total billed charges,90% of total billed charges,778.5,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,766.39,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,276.8,32,,,percent of total billed charges,32% of total billed charges,692,80,,,percent of total billed charges,80% of total billed charges,692,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,787.15,91,,,percent of total billed charges,91% of total billed charges,282.34,32.64,,,percent of total billed charges,32.64% of total billed charges,276.8,32,,,percent of total billed charges,32% of total billed charges,290.64,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,276.8,32,,,percent of total billed charges,32% of total billed charges,276.8,32,,,percent of total billed charges,32% of total billed charges,795.8,92,,,percent of total billed charges,92% of total billed charges,71.76,795.8,
HLA B51,2001783,CDM,301,RC,81373,HCPCS,Outpatient,,,560,476,,454.72,81.2,,,percent of total billed charges,81.2% of total billed charges,182.78,32.64,,,percent of total billed charges,32.64% of total billed charges,414.4,74,,,percent of total billed charges,74% of total billed charges,414.4,74,,,percent of total billed charges,74% of total billed charges,179.2,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,179.2,32,,,percent of total billed charges,32% of total billed charges,397.6,71,,,percent of total billed charges,71% of total billed charges,397.6,71,,,percent of total billed charges,71% of total billed charges,375.2,67,,,percent of total billed charges,67% of total billed charges,375.2,67,,,percent of total billed charges,67% of total billed charges,397.6,71,,,percent of total billed charges,71% of total billed charges,425.6,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,184.58,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,504,90,,,percent of total billed charges,90% of total billed charges,504,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,496.16,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,179.2,32,,,percent of total billed charges,32% of total billed charges,448,80,,,percent of total billed charges,80% of total billed charges,448,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,509.6,91,,,percent of total billed charges,91% of total billed charges,182.78,32.64,,,percent of total billed charges,32.64% of total billed charges,179.2,32,,,percent of total billed charges,32% of total billed charges,188.16,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,179.2,32,,,percent of total billed charges,32% of total billed charges,179.2,32,,,percent of total billed charges,32% of total billed charges,515.2,92,,,percent of total billed charges,92% of total billed charges,71.76,515.2,
HLA B27,2000293,CDM,302,RC,81374,HCPCS,Outpatient,,,111,94.35,,90.13,81.2,,,percent of total billed charges,81.2% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,84.36,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,36.59,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,98.35,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,101.01,91,,,percent of total billed charges,91% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,37.3,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,102.12,92,,,percent of total billed charges,92% of total billed charges,35.52,102.12,
MATERNIT21 PLUS CORE,2001726,CDM,310,RC,81420,HCPCS,Outpatient,,,2499,2124.15,,2029.19,81.2,,,percent of total billed charges,81.2% of total billed charges,815.67,32.64,,,percent of total billed charges,32.64% of total billed charges,1849.26,74,,,percent of total billed charges,74% of total billed charges,1849.26,74,,,percent of total billed charges,74% of total billed charges,799.68,32,,,percent of total billed charges,32% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,799.68,32,,,percent of total billed charges,32% of total billed charges,1774.29,71,,,percent of total billed charges,71% of total billed charges,1774.29,71,,,percent of total billed charges,71% of total billed charges,1674.33,67,,,percent of total billed charges,67% of total billed charges,1674.33,67,,,percent of total billed charges,67% of total billed charges,1774.29,71,,,percent of total billed charges,71% of total billed charges,1899.24,76,,,percent of total billed charges,76% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,823.67,32.96,,,percent of total billed charges,32.96% of total billed charges,70.94,105,,,Fee Schedule,pays based on EAPG rates,2249.1,90,,,percent of total billed charges,90% of total billed charges,2249.1,90,,,percent of total billed charges,90% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,2214.11,88.6,,,percent of total billed charges,88.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,799.68,32,,,percent of total billed charges,32% of total billed charges,1999.2,80,,,percent of total billed charges,80% of total billed charges,1999.2,80,,,percent of total billed charges,80% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,2274.09,91,,,percent of total billed charges,91% of total billed charges,815.67,32.64,,,percent of total billed charges,32.64% of total billed charges,799.68,32,,,percent of total billed charges,32% of total billed charges,839.66,33.6,,,percent of total billed charges,33.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,799.68,32,,,percent of total billed charges,32% of total billed charges,799.68,32,,,percent of total billed charges,32% of total billed charges,2299.08,92,,,percent of total billed charges,92% of total billed charges,67.57,2299.08,
LAB CORP INTELL MYELOID,2001860,CDM,310,RC,81450,HCPCS,Outpatient,,,6433,5468.05,,5223.6,81.2,,,percent of total billed charges,81.2% of total billed charges,2099.73,32.64,,,percent of total billed charges,32.64% of total billed charges,4760.42,74,,,percent of total billed charges,74% of total billed charges,4760.42,74,,,percent of total billed charges,74% of total billed charges,2058.56,32,,,percent of total billed charges,32% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,2058.56,32,,,percent of total billed charges,32% of total billed charges,4567.43,71,,,percent of total billed charges,71% of total billed charges,4567.43,71,,,percent of total billed charges,71% of total billed charges,4310.11,67,,,percent of total billed charges,67% of total billed charges,4310.11,67,,,percent of total billed charges,67% of total billed charges,4567.43,71,,,percent of total billed charges,71% of total billed charges,4889.08,76,,,percent of total billed charges,76% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,2120.32,32.96,,,percent of total billed charges,32.96% of total billed charges,70.94,105,,,Fee Schedule,pays based on EAPG rates,5789.7,90,,,percent of total billed charges,90% of total billed charges,5789.7,90,,,percent of total billed charges,90% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,5699.64,88.6,,,percent of total billed charges,88.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,2058.56,32,,,percent of total billed charges,32% of total billed charges,5146.4,80,,,percent of total billed charges,80% of total billed charges,5146.4,80,,,percent of total billed charges,80% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,5854.03,91,,,percent of total billed charges,91% of total billed charges,2099.73,32.64,,,percent of total billed charges,32.64% of total billed charges,2058.56,32,,,percent of total billed charges,32% of total billed charges,2161.49,33.6,,,percent of total billed charges,33.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,2058.56,32,,,percent of total billed charges,32% of total billed charges,2058.56,32,,,percent of total billed charges,32% of total billed charges,5918.36,92,,,percent of total billed charges,92% of total billed charges,67.57,5918.36,
OSU HC MYELOID NEOPLASM SEQ PANEL,2001867,CDM,310,RC,81450,HCPCS,Outpatient,,,6433,5468.05,,5223.6,81.2,,,percent of total billed charges,81.2% of total billed charges,2099.73,32.64,,,percent of total billed charges,32.64% of total billed charges,4760.42,74,,,percent of total billed charges,74% of total billed charges,4760.42,74,,,percent of total billed charges,74% of total billed charges,2058.56,32,,,percent of total billed charges,32% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,2058.56,32,,,percent of total billed charges,32% of total billed charges,4567.43,71,,,percent of total billed charges,71% of total billed charges,4567.43,71,,,percent of total billed charges,71% of total billed charges,4310.11,67,,,percent of total billed charges,67% of total billed charges,4310.11,67,,,percent of total billed charges,67% of total billed charges,4567.43,71,,,percent of total billed charges,71% of total billed charges,4889.08,76,,,percent of total billed charges,76% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,2120.32,32.96,,,percent of total billed charges,32.96% of total billed charges,70.94,105,,,Fee Schedule,pays based on EAPG rates,5789.7,90,,,percent of total billed charges,90% of total billed charges,5789.7,90,,,percent of total billed charges,90% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,5699.64,88.6,,,percent of total billed charges,88.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,2058.56,32,,,percent of total billed charges,32% of total billed charges,5146.4,80,,,percent of total billed charges,80% of total billed charges,5146.4,80,,,percent of total billed charges,80% of total billed charges,67.57,100,,,Fee Schedule,pays based on EAPG rates,5854.03,91,,,percent of total billed charges,91% of total billed charges,2099.73,32.64,,,percent of total billed charges,32.64% of total billed charges,2058.56,32,,,percent of total billed charges,32% of total billed charges,2161.49,33.6,,,percent of total billed charges,33.6% of total billed charges,69.59,103,,,Fee Schedule,pays based on EAPG rates,2058.56,32,,,percent of total billed charges,32% of total billed charges,2058.56,32,,,percent of total billed charges,32% of total billed charges,5918.36,92,,,percent of total billed charges,92% of total billed charges,67.57,5918.36,
ROMA TESTING,2001352,CDM,310,RC,81500,HCPCS,Outpatient,,,716,608.6,,581.39,81.2,,,percent of total billed charges,81.2% of total billed charges,233.7,32.64,,,percent of total billed charges,32.64% of total billed charges,529.84,74,,,percent of total billed charges,74% of total billed charges,529.84,74,,,percent of total billed charges,74% of total billed charges,229.12,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,229.12,32,,,percent of total billed charges,32% of total billed charges,508.36,71,,,percent of total billed charges,71% of total billed charges,508.36,71,,,percent of total billed charges,71% of total billed charges,479.72,67,,,percent of total billed charges,67% of total billed charges,479.72,67,,,percent of total billed charges,67% of total billed charges,508.36,71,,,percent of total billed charges,71% of total billed charges,544.16,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,235.99,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,644.4,90,,,percent of total billed charges,90% of total billed charges,644.4,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,634.38,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,229.12,32,,,percent of total billed charges,32% of total billed charges,572.8,80,,,percent of total billed charges,80% of total billed charges,572.8,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,651.56,91,,,percent of total billed charges,91% of total billed charges,233.7,32.64,,,percent of total billed charges,32.64% of total billed charges,229.12,32,,,percent of total billed charges,32% of total billed charges,240.58,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,229.12,32,,,percent of total billed charges,32% of total billed charges,229.12,32,,,percent of total billed charges,32% of total billed charges,658.72,92,,,percent of total billed charges,92% of total billed charges,71.76,658.72,
BETA HYDROXYBUTYRATE,2000489,CDM,300,RC,82010,HCPCS,Outpatient,,,39,33.15,,31.67,81.2,,,percent of total billed charges,81.2% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,29.64,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,12.85,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,34.55,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,35.49,91,,,percent of total billed charges,91% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,13.1,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,35.88,92,,,percent of total billed charges,92% of total billed charges,11.18,35.88,
ACTH,2000190,CDM,301,RC,82024,HCPCS,Outpatient,,,184,156.4,,149.41,81.2,,,percent of total billed charges,81.2% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,139.84,76,,,percent of total billed charges,76% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,60.65,32.96,,,percent of total billed charges,32.96% of total billed charges,17.91,105,,,Fee Schedule,pays based on EAPG rates,165.6,90,,,percent of total billed charges,90% of total billed charges,165.6,90,,,percent of total billed charges,90% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,163.02,88.6,,,percent of total billed charges,88.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,167.44,91,,,percent of total billed charges,91% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,61.82,33.6,,,percent of total billed charges,33.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,169.28,92,,,percent of total billed charges,92% of total billed charges,17.05,169.28,
ALBUMIN,2000007,CDM,301,RC,82040,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
ALBUMIN CSF,2001010,CDM,301,RC,82042,HCPCS,Outpatient,,,46,39.1,,37.35,81.2,,,percent of total billed charges,81.2% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,34.96,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.16,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,41.4,90,,,percent of total billed charges,90% of total billed charges,41.4,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,40.76,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,41.86,91,,,percent of total billed charges,91% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,15.46,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,42.32,92,,,percent of total billed charges,92% of total billed charges,7.24,42.32,
BODY FLUID ALBUMIN,2001492,CDM,301,RC,82042,HCPCS,Outpatient,,,46,39.1,,37.35,81.2,,,percent of total billed charges,81.2% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,34.96,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.16,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,41.4,90,,,percent of total billed charges,90% of total billed charges,41.4,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,40.76,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,41.86,91,,,percent of total billed charges,91% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,15.46,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,42.32,92,,,percent of total billed charges,92% of total billed charges,7.24,42.32,
URINE MICROALBUMIN QUANT,2000240,CDM,301,RC,82043,HCPCS,Outpatient,,,64,54.4,,51.97,81.2,,,percent of total billed charges,81.2% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,48.64,76,,,percent of total billed charges,76% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,21.09,32.96,,,percent of total billed charges,32.96% of total billed charges,4.12,105,,,Fee Schedule,pays based on EAPG rates,57.6,90,,,percent of total billed charges,90% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,56.7,88.6,,,percent of total billed charges,88.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,3.93,100,,,Fee Schedule,pays based on EAPG rates,58.24,91,,,percent of total billed charges,91% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,21.5,33.6,,,percent of total billed charges,33.6% of total billed charges,4.04,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,58.88,92,,,percent of total billed charges,92% of total billed charges,3.93,58.88,
ALDOLASE,2000191,CDM,301,RC,82085,HCPCS,Outpatient,,,89,75.65,,72.27,81.2,,,percent of total billed charges,81.2% of total billed charges,29.05,32.64,,,percent of total billed charges,32.64% of total billed charges,65.86,74,,,percent of total billed charges,74% of total billed charges,65.86,74,,,percent of total billed charges,74% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,59.63,67,,,percent of total billed charges,67% of total billed charges,59.63,67,,,percent of total billed charges,67% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,67.64,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.33,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,80.1,90,,,percent of total billed charges,90% of total billed charges,80.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,78.85,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,71.2,80,,,percent of total billed charges,80% of total billed charges,71.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,80.99,91,,,percent of total billed charges,91% of total billed charges,29.05,32.64,,,percent of total billed charges,32.64% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,29.9,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,81.88,92,,,percent of total billed charges,92% of total billed charges,11.18,81.88,
ALDOSTERONE BLOOD,2000192,CDM,301,RC,82088,HCPCS,Outpatient,,,202,171.7,,164.02,81.2,,,percent of total billed charges,81.2% of total billed charges,65.93,32.64,,,percent of total billed charges,32.64% of total billed charges,149.48,74,,,percent of total billed charges,74% of total billed charges,149.48,74,,,percent of total billed charges,74% of total billed charges,64.64,32,,,percent of total billed charges,32% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,64.64,32,,,percent of total billed charges,32% of total billed charges,143.42,71,,,percent of total billed charges,71% of total billed charges,143.42,71,,,percent of total billed charges,71% of total billed charges,135.34,67,,,percent of total billed charges,67% of total billed charges,135.34,67,,,percent of total billed charges,67% of total billed charges,143.42,71,,,percent of total billed charges,71% of total billed charges,153.52,76,,,percent of total billed charges,76% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,66.58,32.96,,,percent of total billed charges,32.96% of total billed charges,17.91,105,,,Fee Schedule,pays based on EAPG rates,181.8,90,,,percent of total billed charges,90% of total billed charges,181.8,90,,,percent of total billed charges,90% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,178.97,88.6,,,percent of total billed charges,88.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,64.64,32,,,percent of total billed charges,32% of total billed charges,161.6,80,,,percent of total billed charges,80% of total billed charges,161.6,80,,,percent of total billed charges,80% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,183.82,91,,,percent of total billed charges,91% of total billed charges,65.93,32.64,,,percent of total billed charges,32.64% of total billed charges,64.64,32,,,percent of total billed charges,32% of total billed charges,67.87,33.6,,,percent of total billed charges,33.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,64.64,32,,,percent of total billed charges,32% of total billed charges,64.64,32,,,percent of total billed charges,32% of total billed charges,185.84,92,,,percent of total billed charges,92% of total billed charges,17.05,185.84,
ALDOSTERONE/RENIN RATIO,2001063,CDM,301,RC,82088,HCPCS,Outpatient,,,202,171.7,,164.02,81.2,,,percent of total billed charges,81.2% of total billed charges,65.93,32.64,,,percent of total billed charges,32.64% of total billed charges,149.48,74,,,percent of total billed charges,74% of total billed charges,149.48,74,,,percent of total billed charges,74% of total billed charges,64.64,32,,,percent of total billed charges,32% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,64.64,32,,,percent of total billed charges,32% of total billed charges,143.42,71,,,percent of total billed charges,71% of total billed charges,143.42,71,,,percent of total billed charges,71% of total billed charges,135.34,67,,,percent of total billed charges,67% of total billed charges,135.34,67,,,percent of total billed charges,67% of total billed charges,143.42,71,,,percent of total billed charges,71% of total billed charges,153.52,76,,,percent of total billed charges,76% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,66.58,32.96,,,percent of total billed charges,32.96% of total billed charges,17.91,105,,,Fee Schedule,pays based on EAPG rates,181.8,90,,,percent of total billed charges,90% of total billed charges,181.8,90,,,percent of total billed charges,90% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,178.97,88.6,,,percent of total billed charges,88.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,64.64,32,,,percent of total billed charges,32% of total billed charges,161.6,80,,,percent of total billed charges,80% of total billed charges,161.6,80,,,percent of total billed charges,80% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,183.82,91,,,percent of total billed charges,91% of total billed charges,65.93,32.64,,,percent of total billed charges,32.64% of total billed charges,64.64,32,,,percent of total billed charges,32% of total billed charges,67.87,33.6,,,percent of total billed charges,33.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,64.64,32,,,percent of total billed charges,32% of total billed charges,64.64,32,,,percent of total billed charges,32% of total billed charges,185.84,92,,,percent of total billed charges,92% of total billed charges,17.05,185.84,
ALPHA 1 ANTITRYPSIN,2000214,CDM,301,RC,82103,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,11.18,85.56,
ALPHA 1 ANTRYPSIN STOOL,2000305,CDM,301,RC,82103,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,11.18,85.56,
AFP MATERNAL ONLY,2001279,CDM,301,RC,82105,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,11.18,93.84,
AFP TUMOR MARKER,2000406,CDM,301,RC,82105,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,11.18,93.84,
AMINO ACID QUAL PROFILE,2001232,CDM,301,RC,82128,HCPCS,Outpatient,,,82,69.7,,66.58,81.2,,,percent of total billed charges,81.2% of total billed charges,26.76,32.64,,,percent of total billed charges,32.64% of total billed charges,60.68,74,,,percent of total billed charges,74% of total billed charges,60.68,74,,,percent of total billed charges,74% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,54.94,67,,,percent of total billed charges,67% of total billed charges,54.94,67,,,percent of total billed charges,67% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,62.32,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.03,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,73.8,90,,,percent of total billed charges,90% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,72.65,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,65.6,80,,,percent of total billed charges,80% of total billed charges,65.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,74.62,91,,,percent of total billed charges,91% of total billed charges,26.76,32.64,,,percent of total billed charges,32.64% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,27.55,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,75.44,92,,,percent of total billed charges,92% of total billed charges,11.18,75.44,
CYSTINE 24 HR URINE QUANT.,2000733,CDM,301,RC,82131,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,11.18,205.16,
AMINOLEVULINIC ACID ALA,2000263,CDM,301,RC,82135,HCPCS,Outpatient,,,111,94.35,,90.13,81.2,,,percent of total billed charges,81.2% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,84.36,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,36.59,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,98.35,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,101.01,91,,,percent of total billed charges,91% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,37.3,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,102.12,92,,,percent of total billed charges,92% of total billed charges,11.18,102.12,
AMMONIA,2000011,CDM,301,RC,82140,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,11.18,74.52,
AMYLASE,2000012,CDM,301,RC,82150,HCPCS,Outpatient,,,61,51.85,,49.53,81.2,,,percent of total billed charges,81.2% of total billed charges,19.91,32.64,,,percent of total billed charges,32.64% of total billed charges,45.14,74,,,percent of total billed charges,74% of total billed charges,45.14,74,,,percent of total billed charges,74% of total billed charges,19.52,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,19.52,32,,,percent of total billed charges,32% of total billed charges,43.31,71,,,percent of total billed charges,71% of total billed charges,43.31,71,,,percent of total billed charges,71% of total billed charges,40.87,67,,,percent of total billed charges,67% of total billed charges,40.87,67,,,percent of total billed charges,67% of total billed charges,43.31,71,,,percent of total billed charges,71% of total billed charges,46.36,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,20.11,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,54.9,90,,,percent of total billed charges,90% of total billed charges,54.9,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,54.05,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,19.52,32,,,percent of total billed charges,32% of total billed charges,48.8,80,,,percent of total billed charges,80% of total billed charges,48.8,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,55.51,91,,,percent of total billed charges,91% of total billed charges,19.91,32.64,,,percent of total billed charges,32.64% of total billed charges,19.52,32,,,percent of total billed charges,32% of total billed charges,20.5,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,19.52,32,,,percent of total billed charges,32% of total billed charges,19.52,32,,,percent of total billed charges,32% of total billed charges,56.12,92,,,percent of total billed charges,92% of total billed charges,7.24,56.12,
BODY FLUID AMYLASE,2001464,CDM,301,RC,82150,HCPCS,Outpatient,,,61,51.85,,49.53,81.2,,,percent of total billed charges,81.2% of total billed charges,19.91,32.64,,,percent of total billed charges,32.64% of total billed charges,45.14,74,,,percent of total billed charges,74% of total billed charges,45.14,74,,,percent of total billed charges,74% of total billed charges,19.52,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,19.52,32,,,percent of total billed charges,32% of total billed charges,43.31,71,,,percent of total billed charges,71% of total billed charges,43.31,71,,,percent of total billed charges,71% of total billed charges,40.87,67,,,percent of total billed charges,67% of total billed charges,40.87,67,,,percent of total billed charges,67% of total billed charges,43.31,71,,,percent of total billed charges,71% of total billed charges,46.36,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,20.11,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,54.9,90,,,percent of total billed charges,90% of total billed charges,54.9,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,54.05,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,19.52,32,,,percent of total billed charges,32% of total billed charges,48.8,80,,,percent of total billed charges,80% of total billed charges,48.8,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,55.51,91,,,percent of total billed charges,91% of total billed charges,19.91,32.64,,,percent of total billed charges,32.64% of total billed charges,19.52,32,,,percent of total billed charges,32% of total billed charges,20.5,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,19.52,32,,,percent of total billed charges,32% of total billed charges,19.52,32,,,percent of total billed charges,32% of total billed charges,56.12,92,,,percent of total billed charges,92% of total billed charges,7.24,56.12,
ANDROSTENEDIONE,2000269,CDM,301,RC,82157,HCPCS,Outpatient,,,161,136.85,,130.73,81.2,,,percent of total billed charges,81.2% of total billed charges,52.55,32.64,,,percent of total billed charges,32.64% of total billed charges,119.14,74,,,percent of total billed charges,74% of total billed charges,119.14,74,,,percent of total billed charges,74% of total billed charges,51.52,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,51.52,32,,,percent of total billed charges,32% of total billed charges,114.31,71,,,percent of total billed charges,71% of total billed charges,114.31,71,,,percent of total billed charges,71% of total billed charges,107.87,67,,,percent of total billed charges,67% of total billed charges,107.87,67,,,percent of total billed charges,67% of total billed charges,114.31,71,,,percent of total billed charges,71% of total billed charges,122.36,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,53.07,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,144.9,90,,,percent of total billed charges,90% of total billed charges,144.9,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,142.65,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,51.52,32,,,percent of total billed charges,32% of total billed charges,128.8,80,,,percent of total billed charges,80% of total billed charges,128.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,146.51,91,,,percent of total billed charges,91% of total billed charges,52.55,32.64,,,percent of total billed charges,32.64% of total billed charges,51.52,32,,,percent of total billed charges,32% of total billed charges,54.1,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,51.52,32,,,percent of total billed charges,32% of total billed charges,51.52,32,,,percent of total billed charges,32% of total billed charges,148.12,92,,,percent of total billed charges,92% of total billed charges,13.55,148.12,
ACE SERUM,2000258,CDM,301,RC,82164,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,11.18,93.84,
ANGIOTENSIN CONVERTING ENZYME CSF,2001096,CDM,301,RC,82164,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,11.18,93.84,
APOLIPOPROTEIN A-1,2001399,CDM,301,RC,82172,HCPCS,Outpatient,,,66,56.1,,53.59,81.2,,,percent of total billed charges,81.2% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,50.16,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.75,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,58.48,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,60.06,91,,,percent of total billed charges,91% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,22.18,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,60.72,92,,,percent of total billed charges,92% of total billed charges,11.18,60.72,
ARSENIC 24 URINE,2001748,CDM,300,RC,82175,HCPCS,Outpatient,,,66,56.1,,53.59,81.2,,,percent of total billed charges,81.2% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,50.16,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,21.75,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,58.48,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,60.06,91,,,percent of total billed charges,91% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,22.18,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,60.72,92,,,percent of total billed charges,92% of total billed charges,9.98,60.72,
ARSENIC WHOLE BLOOD,2000608,CDM,301,RC,82175,HCPCS,Outpatient,,,66,56.1,,53.59,81.2,,,percent of total billed charges,81.2% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,50.16,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,21.75,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,58.48,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,60.06,91,,,percent of total billed charges,91% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,22.18,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,60.72,92,,,percent of total billed charges,92% of total billed charges,9.98,60.72,
BETA 2 MICROGLOBULIN SERUM,2000365,CDM,301,RC,82232,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,13.55,64.4,
BILE ACIDS TOTAL,2000551,CDM,301,RC,82239,HCPCS,Outpatient,,,47,39.95,,38.16,81.2,,,percent of total billed charges,81.2% of total billed charges,15.34,32.64,,,percent of total billed charges,32.64% of total billed charges,34.78,74,,,percent of total billed charges,74% of total billed charges,34.78,74,,,percent of total billed charges,74% of total billed charges,15.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.04,32,,,percent of total billed charges,32% of total billed charges,33.37,71,,,percent of total billed charges,71% of total billed charges,33.37,71,,,percent of total billed charges,71% of total billed charges,31.49,67,,,percent of total billed charges,67% of total billed charges,31.49,67,,,percent of total billed charges,67% of total billed charges,33.37,71,,,percent of total billed charges,71% of total billed charges,35.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.49,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,42.3,90,,,percent of total billed charges,90% of total billed charges,42.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,41.64,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.04,32,,,percent of total billed charges,32% of total billed charges,37.6,80,,,percent of total billed charges,80% of total billed charges,37.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,42.77,91,,,percent of total billed charges,91% of total billed charges,15.34,32.64,,,percent of total billed charges,32.64% of total billed charges,15.04,32,,,percent of total billed charges,32% of total billed charges,15.79,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.04,32,,,percent of total billed charges,32% of total billed charges,15.04,32,,,percent of total billed charges,32% of total billed charges,43.24,92,,,percent of total billed charges,92% of total billed charges,11.18,43.24,
BILIRUBIN NEONATAL,2000151,CDM,301,RC,82247,HCPCS,Outpatient,,,85,72.25,,69.02,81.2,,,percent of total billed charges,81.2% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,64.6,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,28.02,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,75.31,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,77.35,91,,,percent of total billed charges,91% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,28.56,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,78.2,92,,,percent of total billed charges,92% of total billed charges,7.24,78.2,
BILIRUBIN TOTAL,2000017,CDM,301,RC,82247,HCPCS,Outpatient,,,85,72.25,,69.02,81.2,,,percent of total billed charges,81.2% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,62.9,74,,,percent of total billed charges,74% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,56.95,67,,,percent of total billed charges,67% of total billed charges,60.35,71,,,percent of total billed charges,71% of total billed charges,64.6,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,28.02,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,75.31,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,68,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,77.35,91,,,percent of total billed charges,91% of total billed charges,27.74,32.64,,,percent of total billed charges,32.64% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,28.56,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,27.2,32,,,percent of total billed charges,32% of total billed charges,27.2,32,,,percent of total billed charges,32% of total billed charges,78.2,92,,,percent of total billed charges,92% of total billed charges,7.24,78.2,
BILIRUBIN DIRECT,2000184,CDM,301,RC,82248,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
BIOTINIDASE,2001230,CDM,301,RC,82261,HCPCS,Outpatient,,,137,116.45,,111.24,81.2,,,percent of total billed charges,81.2% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,104.12,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.16,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,121.38,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,124.67,91,,,percent of total billed charges,91% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,46.03,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,126.04,92,,,percent of total billed charges,92% of total billed charges,11.18,126.04,
OCCULT BLOOD SLIDES 1 3-CANCER SCREENING,2000104,CDM,301,RC,82270,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,7.24,44.16,
SCREENING OCCULT BLOOD-CANCER SCREENING,2000601,CDM,301,RC,82270,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,7.24,44.16,
OCCULT BLOOD-OTHER THAN CANCER SCREENING,2099036,CDM,301,RC,82272,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,7.24,44.16,
FECAL IMMUNOCHEMICAL TEST,2001336,CDM,301,RC,82274,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,11.18,101.2,
CADMIUM  BLOOD,2000519,CDM,301,RC,82300,HCPCS,Outpatient,,,49,41.65,,39.79,81.2,,,percent of total billed charges,81.2% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,37.24,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,16.15,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,44.1,90,,,percent of total billed charges,90% of total billed charges,44.1,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,43.41,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,44.59,91,,,percent of total billed charges,91% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,16.46,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,45.08,92,,,percent of total billed charges,92% of total billed charges,9.98,45.08,
CADMIUM 24 URINE,2001749,CDM,300,RC,82300,HCPCS,Outpatient,,,49,41.65,,39.79,81.2,,,percent of total billed charges,81.2% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,37.24,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,16.15,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,44.1,90,,,percent of total billed charges,90% of total billed charges,44.1,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,43.41,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,44.59,91,,,percent of total billed charges,91% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,16.46,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,45.08,92,,,percent of total billed charges,92% of total billed charges,9.98,45.08,
VITAMIN D 25 HYDROXY,2000582,CDM,301,RC,82306,HCPCS,Outpatient,,,145,123.25,,117.74,81.2,,,percent of total billed charges,81.2% of total billed charges,47.33,32.64,,,percent of total billed charges,32.64% of total billed charges,107.3,74,,,percent of total billed charges,74% of total billed charges,107.3,74,,,percent of total billed charges,74% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,97.15,67,,,percent of total billed charges,67% of total billed charges,97.15,67,,,percent of total billed charges,67% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,110.2,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,47.79,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,130.5,90,,,percent of total billed charges,90% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,128.47,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,131.95,91,,,percent of total billed charges,91% of total billed charges,47.33,32.64,,,percent of total billed charges,32.64% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,48.72,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,133.4,92,,,percent of total billed charges,92% of total billed charges,12.85,133.4,
CALCIUM TOTAL,2000020,CDM,301,RC,82310,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
CALCIUM IONIZED,2000180,CDM,301,RC,82330,HCPCS,Outpatient,,,66,56.1,,53.59,81.2,,,percent of total billed charges,81.2% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,50.16,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.75,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,58.48,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,60.06,91,,,percent of total billed charges,91% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,22.18,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,60.72,92,,,percent of total billed charges,92% of total billed charges,11.18,60.72,
CALCIUM URINE 24 HOUR,2000298,CDM,301,RC,82340,HCPCS,Outpatient,,,59,50.15,,47.91,81.2,,,percent of total billed charges,81.2% of total billed charges,19.26,32.64,,,percent of total billed charges,32.64% of total billed charges,43.66,74,,,percent of total billed charges,74% of total billed charges,43.66,74,,,percent of total billed charges,74% of total billed charges,18.88,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.88,32,,,percent of total billed charges,32% of total billed charges,41.89,71,,,percent of total billed charges,71% of total billed charges,41.89,71,,,percent of total billed charges,71% of total billed charges,39.53,67,,,percent of total billed charges,67% of total billed charges,39.53,67,,,percent of total billed charges,67% of total billed charges,41.89,71,,,percent of total billed charges,71% of total billed charges,44.84,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,19.45,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,53.1,90,,,percent of total billed charges,90% of total billed charges,53.1,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,52.27,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.88,32,,,percent of total billed charges,32% of total billed charges,47.2,80,,,percent of total billed charges,80% of total billed charges,47.2,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,53.69,91,,,percent of total billed charges,91% of total billed charges,19.26,32.64,,,percent of total billed charges,32.64% of total billed charges,18.88,32,,,percent of total billed charges,32% of total billed charges,19.82,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.88,32,,,percent of total billed charges,32% of total billed charges,18.88,32,,,percent of total billed charges,32% of total billed charges,54.28,92,,,percent of total billed charges,92% of total billed charges,7.24,54.28,
RENAL CALCULUS ANALYSIS,2000394,CDM,300,RC,82360,HCPCS,Outpatient,,,312,265.2,,253.34,81.2,,,percent of total billed charges,81.2% of total billed charges,101.84,32.64,,,percent of total billed charges,32.64% of total billed charges,230.88,74,,,percent of total billed charges,74% of total billed charges,230.88,74,,,percent of total billed charges,74% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,209.04,67,,,percent of total billed charges,67% of total billed charges,209.04,67,,,percent of total billed charges,67% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,237.12,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,102.84,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,280.8,90,,,percent of total billed charges,90% of total billed charges,280.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,276.43,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,283.92,91,,,percent of total billed charges,91% of total billed charges,101.84,32.64,,,percent of total billed charges,32.64% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,104.83,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,287.04,92,,,percent of total billed charges,92% of total billed charges,11.18,287.04,
CARBON DIOXIDE,2000021,CDM,301,RC,82374,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
CARBON MONOXID QUANT,2000178,CDM,301,RC,82375,HCPCS,Outpatient,,,64,54.4,,51.97,81.2,,,percent of total billed charges,81.2% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,48.64,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.09,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,57.6,90,,,percent of total billed charges,90% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,56.7,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,58.24,91,,,percent of total billed charges,91% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,21.5,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,58.88,92,,,percent of total billed charges,92% of total billed charges,11.18,58.88,
CARCINEOMBRYO ANTIGEN CEA,2000022,CDM,301,RC,82378,HCPCS,Outpatient,,,143,121.55,,116.12,81.2,,,percent of total billed charges,81.2% of total billed charges,46.68,32.64,,,percent of total billed charges,32.64% of total billed charges,105.82,74,,,percent of total billed charges,74% of total billed charges,105.82,74,,,percent of total billed charges,74% of total billed charges,45.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.76,32,,,percent of total billed charges,32% of total billed charges,101.53,71,,,percent of total billed charges,71% of total billed charges,101.53,71,,,percent of total billed charges,71% of total billed charges,95.81,67,,,percent of total billed charges,67% of total billed charges,95.81,67,,,percent of total billed charges,67% of total billed charges,101.53,71,,,percent of total billed charges,71% of total billed charges,108.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,47.13,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,128.7,90,,,percent of total billed charges,90% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,126.7,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.76,32,,,percent of total billed charges,32% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,130.13,91,,,percent of total billed charges,91% of total billed charges,46.68,32.64,,,percent of total billed charges,32.64% of total billed charges,45.76,32,,,percent of total billed charges,32% of total billed charges,48.05,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.76,32,,,percent of total billed charges,32% of total billed charges,45.76,32,,,percent of total billed charges,32% of total billed charges,131.56,92,,,percent of total billed charges,92% of total billed charges,11.18,131.56,
24 HOUR CATECHOLAMINES URINE,2001108,CDM,301,RC,82382,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,13.55,91.08,
URINE CATECHOLAMINES RANDOM,2000023,CDM,301,RC,82382,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,13.55,91.08,
CATECHOLAMINES PLASMA,2000562,CDM,301,RC,82383,HCPCS,Outpatient,,,106,90.1,,86.07,81.2,,,percent of total billed charges,81.2% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,80.56,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.94,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,93.92,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,96.46,91,,,percent of total billed charges,91% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,35.62,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,97.52,92,,,percent of total billed charges,92% of total billed charges,13.55,97.52,
CATECHOLAMINES FRACTIONATION 24 HR UR,2000330,CDM,301,RC,82384,HCPCS,Outpatient,,,184,156.4,,149.41,81.2,,,percent of total billed charges,81.2% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,139.84,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,60.65,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,165.6,90,,,percent of total billed charges,90% of total billed charges,165.6,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,163.02,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,167.44,91,,,percent of total billed charges,91% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,61.82,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,169.28,92,,,percent of total billed charges,92% of total billed charges,13.55,169.28,
CERULOPLASMIN,2000216,CDM,301,RC,82390,HCPCS,Outpatient,,,66,56.1,,53.59,81.2,,,percent of total billed charges,81.2% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,50.16,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.75,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,58.48,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,60.06,91,,,percent of total billed charges,91% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,22.18,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,60.72,92,,,percent of total billed charges,92% of total billed charges,11.18,60.72,
ANTI-ADALIMUMAB ANTIBODY,2001729,CDM,300,RC,82397,HCPCS,Outpatient,,,69,58.65,,56.03,81.2,,,percent of total billed charges,81.2% of total billed charges,22.52,32.64,,,percent of total billed charges,32.64% of total billed charges,51.06,74,,,percent of total billed charges,74% of total billed charges,51.06,74,,,percent of total billed charges,74% of total billed charges,22.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.08,32,,,percent of total billed charges,32% of total billed charges,48.99,71,,,percent of total billed charges,71% of total billed charges,48.99,71,,,percent of total billed charges,71% of total billed charges,46.23,67,,,percent of total billed charges,67% of total billed charges,46.23,67,,,percent of total billed charges,67% of total billed charges,48.99,71,,,percent of total billed charges,71% of total billed charges,52.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.74,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,62.1,90,,,percent of total billed charges,90% of total billed charges,62.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,61.13,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.08,32,,,percent of total billed charges,32% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,62.79,91,,,percent of total billed charges,91% of total billed charges,22.52,32.64,,,percent of total billed charges,32.64% of total billed charges,22.08,32,,,percent of total billed charges,32% of total billed charges,23.18,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.08,32,,,percent of total billed charges,32% of total billed charges,22.08,32,,,percent of total billed charges,32% of total billed charges,63.48,92,,,percent of total billed charges,92% of total billed charges,11.18,63.48,
PARATHYROID RELATED PEPTID HOR,2000767,CDM,300,RC,82397,HCPCS,Outpatient,,,69,58.65,,56.03,81.2,,,percent of total billed charges,81.2% of total billed charges,22.52,32.64,,,percent of total billed charges,32.64% of total billed charges,51.06,74,,,percent of total billed charges,74% of total billed charges,51.06,74,,,percent of total billed charges,74% of total billed charges,22.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.08,32,,,percent of total billed charges,32% of total billed charges,48.99,71,,,percent of total billed charges,71% of total billed charges,48.99,71,,,percent of total billed charges,71% of total billed charges,46.23,67,,,percent of total billed charges,67% of total billed charges,46.23,67,,,percent of total billed charges,67% of total billed charges,48.99,71,,,percent of total billed charges,71% of total billed charges,52.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.74,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,62.1,90,,,percent of total billed charges,90% of total billed charges,62.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,61.13,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.08,32,,,percent of total billed charges,32% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,55.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,62.79,91,,,percent of total billed charges,91% of total billed charges,22.52,32.64,,,percent of total billed charges,32.64% of total billed charges,22.08,32,,,percent of total billed charges,32% of total billed charges,23.18,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.08,32,,,percent of total billed charges,32% of total billed charges,22.08,32,,,percent of total billed charges,32% of total billed charges,63.48,92,,,percent of total billed charges,92% of total billed charges,11.18,63.48,
CHLORIDE,2000025,CDM,301,RC,82435,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,7.24,44.16,
CHLORIDE URINE,2000335,CDM,301,RC,82436,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,7.24,46,
CHOLESTEROL,2000026,CDM,301,RC,82465,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,7.24,69,
CHROMIUM BLOOD,2000175,CDM,301,RC,82495,HCPCS,Outpatient,,,270,229.5,,219.24,81.2,,,percent of total billed charges,81.2% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,205.2,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,88.99,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,239.22,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,245.7,91,,,percent of total billed charges,91% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,90.72,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,248.4,92,,,percent of total billed charges,92% of total billed charges,9.98,248.4,
"CITRIC ACID, URINE 24 HOUR",2000397,CDM,301,RC,82507,HCPCS,Outpatient,,,168,142.8,,136.42,81.2,,,percent of total billed charges,81.2% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,127.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,55.37,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,148.85,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,152.88,91,,,percent of total billed charges,91% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,56.45,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,154.56,92,,,percent of total billed charges,92% of total billed charges,11.18,154.56,
COPPER PLASMA,2000172,CDM,301,RC,82525,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,9.98,70.84,
COPPER URINE,2000173,CDM,301,RC,82525,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,9.98,70.84,
SALIVARY CORTISOL FREE,2000964,CDM,301,RC,82530,HCPCS,Outpatient,,,315,267.75,,255.78,81.2,,,percent of total billed charges,81.2% of total billed charges,102.82,32.64,,,percent of total billed charges,32.64% of total billed charges,233.1,74,,,percent of total billed charges,74% of total billed charges,233.1,74,,,percent of total billed charges,74% of total billed charges,100.8,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,100.8,32,,,percent of total billed charges,32% of total billed charges,223.65,71,,,percent of total billed charges,71% of total billed charges,223.65,71,,,percent of total billed charges,71% of total billed charges,211.05,67,,,percent of total billed charges,67% of total billed charges,211.05,67,,,percent of total billed charges,67% of total billed charges,223.65,71,,,percent of total billed charges,71% of total billed charges,239.4,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,103.82,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,279.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,100.8,32,,,percent of total billed charges,32% of total billed charges,252,80,,,percent of total billed charges,80% of total billed charges,252,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,286.65,91,,,percent of total billed charges,91% of total billed charges,102.82,32.64,,,percent of total billed charges,32.64% of total billed charges,100.8,32,,,percent of total billed charges,32% of total billed charges,105.84,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,100.8,32,,,percent of total billed charges,32% of total billed charges,100.8,32,,,percent of total billed charges,32% of total billed charges,289.8,92,,,percent of total billed charges,92% of total billed charges,11.18,289.8,
CORTISOL,2001099,CDM,301,RC,82533,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,13.55,94.76,
CORTISOL 3 SPECIMENS,2001378,CDM,301,RC,82533,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,13.55,94.76,
CORTISOL AM,2000031,CDM,301,RC,82533,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,13.55,94.76,
CORTISOL DEXAMETHASONE REFLEX,2001786,CDM,300,RC,82533,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,13.55,94.76,
CORTISOL PM,2000032,CDM,301,RC,82533,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,13.55,94.76,
CORTISOL URINE,2000426,CDM,301,RC,82533,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,13.55,94.76,
CREATINE URINE,2000437,CDM,301,RC,82540,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,7.24,41.4,
CORTISONE SERUM,2001416,CDM,301,RC,82542,HCPCS,Outpatient,,,184,156.4,,149.41,81.2,,,percent of total billed charges,81.2% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,139.84,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,60.65,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,165.6,90,,,percent of total billed charges,90% of total billed charges,165.6,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,163.02,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,167.44,91,,,percent of total billed charges,91% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,61.82,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,169.28,92,,,percent of total billed charges,92% of total billed charges,11.18,169.28,
TPMT ENZYME ACTIVIITY,2000698,CDM,301,RC,82542,HCPCS,Outpatient,,,184,156.4,,149.41,81.2,,,percent of total billed charges,81.2% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,139.84,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,60.65,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,165.6,90,,,percent of total billed charges,90% of total billed charges,165.6,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,163.02,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,167.44,91,,,percent of total billed charges,91% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,61.82,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,169.28,92,,,percent of total billed charges,92% of total billed charges,11.18,169.28,
ZONEGRAM,2000755,CDM,301,RC,82542,HCPCS,Outpatient,,,184,156.4,,149.41,81.2,,,percent of total billed charges,81.2% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,136.16,74,,,percent of total billed charges,74% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,123.28,67,,,percent of total billed charges,67% of total billed charges,130.64,71,,,percent of total billed charges,71% of total billed charges,139.84,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,60.65,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,165.6,90,,,percent of total billed charges,90% of total billed charges,165.6,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,163.02,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,147.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,167.44,91,,,percent of total billed charges,91% of total billed charges,60.06,32.64,,,percent of total billed charges,32.64% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,61.82,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,58.88,32,,,percent of total billed charges,32% of total billed charges,58.88,32,,,percent of total billed charges,32% of total billed charges,169.28,92,,,percent of total billed charges,92% of total billed charges,11.18,169.28,
CPK/CKI TOTAL,2000034,CDM,301,RC,82550,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,7.24,46,
CPK ISOENZYMES,2000033,CDM,301,RC,82552,HCPCS,Outpatient,,,78,66.3,,63.34,81.2,,,percent of total billed charges,81.2% of total billed charges,25.46,32.64,,,percent of total billed charges,32.64% of total billed charges,57.72,74,,,percent of total billed charges,74% of total billed charges,57.72,74,,,percent of total billed charges,74% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,52.26,67,,,percent of total billed charges,67% of total billed charges,52.26,67,,,percent of total billed charges,67% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,59.28,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,25.71,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,70.2,90,,,percent of total billed charges,90% of total billed charges,70.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,69.11,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,62.4,80,,,percent of total billed charges,80% of total billed charges,62.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,70.98,91,,,percent of total billed charges,91% of total billed charges,25.46,32.64,,,percent of total billed charges,32.64% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,26.21,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,71.76,92,,,percent of total billed charges,92% of total billed charges,11.18,71.76,
CPK MB,2000244,CDM,301,RC,82553,HCPCS,Outpatient,,,71,60.35,,57.65,81.2,,,percent of total billed charges,81.2% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,53.96,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,23.4,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,63.9,90,,,percent of total billed charges,90% of total billed charges,63.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,62.91,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,64.61,91,,,percent of total billed charges,91% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,23.86,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,65.32,92,,,percent of total billed charges,92% of total billed charges,11.18,65.32,
CREATININE,2000035,CDM,301,RC,82565,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
CREATININE URINE 24 HOUR,2000036,CDM,301,RC,82570,HCPCS,Outpatient,,,67,56.95,,54.4,81.2,,,percent of total billed charges,81.2% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,50.92,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.08,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,60.3,90,,,percent of total billed charges,90% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,59.36,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,60.97,91,,,percent of total billed charges,91% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,22.51,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,61.64,92,,,percent of total billed charges,92% of total billed charges,7.24,61.64,
CREATININE URINE RANDOM,2000680,CDM,301,RC,82570,HCPCS,Outpatient,,,67,56.95,,54.4,81.2,,,percent of total billed charges,81.2% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,50.92,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.08,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,60.3,90,,,percent of total billed charges,90% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,59.36,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,60.97,91,,,percent of total billed charges,91% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,22.51,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,61.64,92,,,percent of total billed charges,92% of total billed charges,7.24,61.64,
URINE CREATININE CLEARANCE,2000037,CDM,301,RC,82575,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,11.18,93.84,
VITAMIN B12,2000146,CDM,301,RC,82607,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,13.55,93.84,
CYSTATIN C,2001050,CDM,301,RC,82610,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,11.18,70.84,
HOMOCYSTINE URINE,2000834,CDM,301,RC,82615,HCPCS,Outpatient,,,225,191.25,,182.7,81.2,,,percent of total billed charges,81.2% of total billed charges,73.44,32.64,,,percent of total billed charges,32.64% of total billed charges,166.5,74,,,percent of total billed charges,74% of total billed charges,166.5,74,,,percent of total billed charges,74% of total billed charges,72,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,72,32,,,percent of total billed charges,32% of total billed charges,159.75,71,,,percent of total billed charges,71% of total billed charges,159.75,71,,,percent of total billed charges,71% of total billed charges,150.75,67,,,percent of total billed charges,67% of total billed charges,150.75,67,,,percent of total billed charges,67% of total billed charges,159.75,71,,,percent of total billed charges,71% of total billed charges,171,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,74.16,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,202.5,90,,,percent of total billed charges,90% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,199.35,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,72,32,,,percent of total billed charges,32% of total billed charges,180,80,,,percent of total billed charges,80% of total billed charges,180,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,204.75,91,,,percent of total billed charges,91% of total billed charges,73.44,32.64,,,percent of total billed charges,32.64% of total billed charges,72,32,,,percent of total billed charges,32% of total billed charges,75.6,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,72,32,,,percent of total billed charges,32% of total billed charges,72,32,,,percent of total billed charges,32% of total billed charges,207,92,,,percent of total billed charges,92% of total billed charges,11.18,207,
DHEA,2000208,CDM,301,RC,82626,HCPCS,Outpatient,,,149,126.65,,120.99,81.2,,,percent of total billed charges,81.2% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,113.24,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,49.11,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,132.01,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,135.59,91,,,percent of total billed charges,91% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,50.06,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,137.08,92,,,percent of total billed charges,92% of total billed charges,11.18,137.08,
DHEA S,2000209,CDM,301,RC,82627,HCPCS,Outpatient,,,146,124.1,,118.55,81.2,,,percent of total billed charges,81.2% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,110.96,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,48.12,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,129.36,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,132.86,91,,,percent of total billed charges,91% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,49.06,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,134.32,92,,,percent of total billed charges,92% of total billed charges,13.55,134.32,
11-DESOXYCORTISOL,2001275,CDM,301,RC,82634,HCPCS,Outpatient,,,92,78.2,,74.7,81.2,,,percent of total billed charges,81.2% of total billed charges,30.03,32.64,,,percent of total billed charges,32.64% of total billed charges,68.08,74,,,percent of total billed charges,74% of total billed charges,68.08,74,,,percent of total billed charges,74% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,61.64,67,,,percent of total billed charges,67% of total billed charges,61.64,67,,,percent of total billed charges,67% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,69.92,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,30.32,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,82.8,90,,,percent of total billed charges,90% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,81.51,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,73.6,80,,,percent of total billed charges,80% of total billed charges,73.6,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,83.72,91,,,percent of total billed charges,91% of total billed charges,30.03,32.64,,,percent of total billed charges,32.64% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,30.91,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,84.64,92,,,percent of total billed charges,92% of total billed charges,13.55,84.64,
"VITAMIN D 1,25 DIHYDRO",2000227,CDM,301,RC,82652,HCPCS,Outpatient,,,198,168.3,,160.78,81.2,,,percent of total billed charges,81.2% of total billed charges,64.63,32.64,,,percent of total billed charges,32.64% of total billed charges,146.52,74,,,percent of total billed charges,74% of total billed charges,146.52,74,,,percent of total billed charges,74% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,132.66,67,,,percent of total billed charges,67% of total billed charges,132.66,67,,,percent of total billed charges,67% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,150.48,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,65.26,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,178.2,90,,,percent of total billed charges,90% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,175.43,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,158.4,80,,,percent of total billed charges,80% of total billed charges,158.4,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,180.18,91,,,percent of total billed charges,91% of total billed charges,64.63,32.64,,,percent of total billed charges,32.64% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,66.53,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,182.16,92,,,percent of total billed charges,92% of total billed charges,12.85,182.16,
PANCREATIC ELASTASE 1,2001018,CDM,300,RC,82656,HCPCS,Outpatient,,,337,286.45,,273.64,81.2,,,percent of total billed charges,81.2% of total billed charges,110,32.64,,,percent of total billed charges,32.64% of total billed charges,249.38,74,,,percent of total billed charges,74% of total billed charges,249.38,74,,,percent of total billed charges,74% of total billed charges,107.84,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,107.84,32,,,percent of total billed charges,32% of total billed charges,239.27,71,,,percent of total billed charges,71% of total billed charges,239.27,71,,,percent of total billed charges,71% of total billed charges,225.79,67,,,percent of total billed charges,67% of total billed charges,225.79,67,,,percent of total billed charges,67% of total billed charges,239.27,71,,,percent of total billed charges,71% of total billed charges,256.12,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,111.08,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,303.3,90,,,percent of total billed charges,90% of total billed charges,303.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,298.58,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,107.84,32,,,percent of total billed charges,32% of total billed charges,269.6,80,,,percent of total billed charges,80% of total billed charges,269.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,306.67,91,,,percent of total billed charges,91% of total billed charges,110,32.64,,,percent of total billed charges,32.64% of total billed charges,107.84,32,,,percent of total billed charges,32% of total billed charges,113.23,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,107.84,32,,,percent of total billed charges,32% of total billed charges,107.84,32,,,percent of total billed charges,32% of total billed charges,310.04,92,,,percent of total billed charges,92% of total billed charges,11.18,310.04,
LYSOSOMAL ACID LIPASE (LAL),2001779,CDM,300,RC,82657,HCPCS,Outpatient,,,484,411.4,,393.01,81.2,,,percent of total billed charges,81.2% of total billed charges,157.98,32.64,,,percent of total billed charges,32.64% of total billed charges,358.16,74,,,percent of total billed charges,74% of total billed charges,358.16,74,,,percent of total billed charges,74% of total billed charges,154.88,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,154.88,32,,,percent of total billed charges,32% of total billed charges,343.64,71,,,percent of total billed charges,71% of total billed charges,343.64,71,,,percent of total billed charges,71% of total billed charges,324.28,67,,,percent of total billed charges,67% of total billed charges,324.28,67,,,percent of total billed charges,67% of total billed charges,343.64,71,,,percent of total billed charges,71% of total billed charges,367.84,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,159.53,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,435.6,90,,,percent of total billed charges,90% of total billed charges,435.6,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,428.82,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,154.88,32,,,percent of total billed charges,32% of total billed charges,387.2,80,,,percent of total billed charges,80% of total billed charges,387.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,440.44,91,,,percent of total billed charges,91% of total billed charges,157.98,32.64,,,percent of total billed charges,32.64% of total billed charges,154.88,32,,,percent of total billed charges,32% of total billed charges,162.62,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,154.88,32,,,percent of total billed charges,32% of total billed charges,154.88,32,,,percent of total billed charges,32% of total billed charges,445.28,92,,,percent of total billed charges,92% of total billed charges,11.18,445.28,
ERYTHROPOETEIN,2000280,CDM,301,RC,82668,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,11.18,79.12,
ESTRADIOL,2000231,CDM,300,RC,82670,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,13.55,41.4,
ESTRADIOL (SENSITIVE),2000246,CDM,301,RC,82670,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,13.55,41.4,
FRACTIONATED ESTROGEN,2001345,CDM,301,RC,82671,HCPCS,Outpatient,,,385,327.25,,312.62,81.2,,,percent of total billed charges,81.2% of total billed charges,125.66,32.64,,,percent of total billed charges,32.64% of total billed charges,284.9,74,,,percent of total billed charges,74% of total billed charges,284.9,74,,,percent of total billed charges,74% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,257.95,67,,,percent of total billed charges,67% of total billed charges,257.95,67,,,percent of total billed charges,67% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,292.6,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,126.9,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,346.5,90,,,percent of total billed charges,90% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,341.11,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,308,80,,,percent of total billed charges,80% of total billed charges,308,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,350.35,91,,,percent of total billed charges,91% of total billed charges,125.66,32.64,,,percent of total billed charges,32.64% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,129.36,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,354.2,92,,,percent of total billed charges,92% of total billed charges,13.55,354.2,
ESTROGENS TOTAL SERUM,2000169,CDM,301,RC,82672,HCPCS,Outpatient,,,275,233.75,,223.3,81.2,,,percent of total billed charges,81.2% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,209,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,90.64,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,247.5,90,,,percent of total billed charges,90% of total billed charges,247.5,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,243.65,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,250.25,91,,,percent of total billed charges,91% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,92.4,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,253,92,,,percent of total billed charges,92% of total billed charges,13.55,253,
ESTRIOL,2000481,CDM,301,RC,82677,HCPCS,Outpatient,,,190,161.5,,154.28,81.2,,,percent of total billed charges,81.2% of total billed charges,62.02,32.64,,,percent of total billed charges,32.64% of total billed charges,140.6,74,,,percent of total billed charges,74% of total billed charges,140.6,74,,,percent of total billed charges,74% of total billed charges,60.8,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,60.8,32,,,percent of total billed charges,32% of total billed charges,134.9,71,,,percent of total billed charges,71% of total billed charges,134.9,71,,,percent of total billed charges,71% of total billed charges,127.3,67,,,percent of total billed charges,67% of total billed charges,127.3,67,,,percent of total billed charges,67% of total billed charges,134.9,71,,,percent of total billed charges,71% of total billed charges,144.4,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,62.62,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,168.34,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,60.8,32,,,percent of total billed charges,32% of total billed charges,152,80,,,percent of total billed charges,80% of total billed charges,152,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,172.9,91,,,percent of total billed charges,91% of total billed charges,62.02,32.64,,,percent of total billed charges,32.64% of total billed charges,60.8,32,,,percent of total billed charges,32% of total billed charges,63.84,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,60.8,32,,,percent of total billed charges,32% of total billed charges,60.8,32,,,percent of total billed charges,32% of total billed charges,174.8,92,,,percent of total billed charges,92% of total billed charges,13.55,174.8,
FATS FECES QUALITATIVE,2000168,CDM,301,RC,82705,HCPCS,Outpatient,,,37,31.45,,30.04,81.2,,,percent of total billed charges,81.2% of total billed charges,12.08,32.64,,,percent of total billed charges,32.64% of total billed charges,27.38,74,,,percent of total billed charges,74% of total billed charges,27.38,74,,,percent of total billed charges,74% of total billed charges,11.84,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,11.84,32,,,percent of total billed charges,32% of total billed charges,26.27,71,,,percent of total billed charges,71% of total billed charges,26.27,71,,,percent of total billed charges,71% of total billed charges,24.79,67,,,percent of total billed charges,67% of total billed charges,24.79,67,,,percent of total billed charges,67% of total billed charges,26.27,71,,,percent of total billed charges,71% of total billed charges,28.12,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,12.2,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,33.3,90,,,percent of total billed charges,90% of total billed charges,33.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,32.78,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,11.84,32,,,percent of total billed charges,32% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,33.67,91,,,percent of total billed charges,91% of total billed charges,12.08,32.64,,,percent of total billed charges,32.64% of total billed charges,11.84,32,,,percent of total billed charges,32% of total billed charges,12.43,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,11.84,32,,,percent of total billed charges,32% of total billed charges,11.84,32,,,percent of total billed charges,32% of total billed charges,34.04,92,,,percent of total billed charges,92% of total billed charges,7.24,34.04,
FREE FATTY ACID TOTAL,2000950,CDM,300,RC,82725,HCPCS,Outpatient,,,78,66.3,,63.34,81.2,,,percent of total billed charges,81.2% of total billed charges,25.46,32.64,,,percent of total billed charges,32.64% of total billed charges,57.72,74,,,percent of total billed charges,74% of total billed charges,57.72,74,,,percent of total billed charges,74% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,52.26,67,,,percent of total billed charges,67% of total billed charges,52.26,67,,,percent of total billed charges,67% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,59.28,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,25.71,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,70.2,90,,,percent of total billed charges,90% of total billed charges,70.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,69.11,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,62.4,80,,,percent of total billed charges,80% of total billed charges,62.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,70.98,91,,,percent of total billed charges,91% of total billed charges,25.46,32.64,,,percent of total billed charges,32.64% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,26.21,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,71.76,92,,,percent of total billed charges,92% of total billed charges,11.18,71.76,
FERRITIN,2000058,CDM,301,RC,82728,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,11.18,85.56,
FETAL FIBRONECTIN,2000634,CDM,301,RC,82731,HCPCS,Outpatient,,,455,386.75,,369.46,81.2,,,percent of total billed charges,81.2% of total billed charges,148.51,32.64,,,percent of total billed charges,32.64% of total billed charges,336.7,74,,,percent of total billed charges,74% of total billed charges,336.7,74,,,percent of total billed charges,74% of total billed charges,145.6,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,145.6,32,,,percent of total billed charges,32% of total billed charges,323.05,71,,,percent of total billed charges,71% of total billed charges,323.05,71,,,percent of total billed charges,71% of total billed charges,304.85,67,,,percent of total billed charges,67% of total billed charges,304.85,67,,,percent of total billed charges,67% of total billed charges,323.05,71,,,percent of total billed charges,71% of total billed charges,345.8,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,149.97,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,409.5,90,,,percent of total billed charges,90% of total billed charges,409.5,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,403.13,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,145.6,32,,,percent of total billed charges,32% of total billed charges,364,80,,,percent of total billed charges,80% of total billed charges,364,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,414.05,91,,,percent of total billed charges,91% of total billed charges,148.51,32.64,,,percent of total billed charges,32.64% of total billed charges,145.6,32,,,percent of total billed charges,32% of total billed charges,152.88,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,145.6,32,,,percent of total billed charges,32% of total billed charges,145.6,32,,,percent of total billed charges,32% of total billed charges,418.6,92,,,percent of total billed charges,92% of total billed charges,12.85,418.6,
FOLATE SERUM FOLIC ACID,2000061,CDM,301,RC,82746,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,11.18,101.2,
GALACTOSE  1 PHOS.-URIDYL QUANT,2000462,CDM,301,RC,82775,HCPCS,Outpatient,,,190,161.5,,154.28,81.2,,,percent of total billed charges,81.2% of total billed charges,62.02,32.64,,,percent of total billed charges,32.64% of total billed charges,140.6,74,,,percent of total billed charges,74% of total billed charges,140.6,74,,,percent of total billed charges,74% of total billed charges,60.8,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,60.8,32,,,percent of total billed charges,32% of total billed charges,134.9,71,,,percent of total billed charges,71% of total billed charges,134.9,71,,,percent of total billed charges,71% of total billed charges,127.3,67,,,percent of total billed charges,67% of total billed charges,127.3,67,,,percent of total billed charges,67% of total billed charges,134.9,71,,,percent of total billed charges,71% of total billed charges,144.4,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,62.62,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,168.34,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,60.8,32,,,percent of total billed charges,32% of total billed charges,152,80,,,percent of total billed charges,80% of total billed charges,152,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,172.9,91,,,percent of total billed charges,91% of total billed charges,62.02,32.64,,,percent of total billed charges,32.64% of total billed charges,60.8,32,,,percent of total billed charges,32% of total billed charges,63.84,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,60.8,32,,,percent of total billed charges,32% of total billed charges,60.8,32,,,percent of total billed charges,32% of total billed charges,174.8,92,,,percent of total billed charges,92% of total billed charges,11.18,174.8,
"CELIAC SCREEN (includes gliadin,tTG IgA)",2000419,CDM,302,RC,82784,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,11.18,112.24,
"CELIACComprehen-gladin,tTG,IgA,edomysial",2000908,CDM,300,RC,82784,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,11.18,112.24,
CSF IGG INDEX,2000683,CDM,301,RC,82784,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,11.18,112.24,
CSF IGG SYNTHESIS RATE,2001069,CDM,301,RC,82784,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,11.18,112.24,
IGA,2000086,CDM,301,RC,82784,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,11.18,112.24,
IGG,2000088,CDM,301,RC,82784,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,11.18,112.24,
IGM,2000089,CDM,301,RC,82784,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,11.18,112.24,
IGE,2000087,CDM,301,RC,82785,HCPCS,Outpatient,,,106,90.1,,86.07,81.2,,,percent of total billed charges,81.2% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,80.56,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.94,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,93.92,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,96.46,91,,,percent of total billed charges,91% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,35.62,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,97.52,92,,,percent of total billed charges,92% of total billed charges,11.18,97.52,
IgG SUBCLASSES 1 2 3 4,2000427,CDM,301,RC,82787,HCPCS,Outpatient,,,111,94.35,,90.13,81.2,,,percent of total billed charges,81.2% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,84.36,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,36.59,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,98.35,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,101.01,91,,,percent of total billed charges,91% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,37.3,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,102.12,92,,,percent of total billed charges,92% of total billed charges,11.18,102.12,
GASTRIN,2000064,CDM,301,RC,82941,HCPCS,Outpatient,,,121,102.85,,98.25,81.2,,,percent of total billed charges,81.2% of total billed charges,39.49,32.64,,,percent of total billed charges,32.64% of total billed charges,89.54,74,,,percent of total billed charges,74% of total billed charges,89.54,74,,,percent of total billed charges,74% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,81.07,67,,,percent of total billed charges,67% of total billed charges,81.07,67,,,percent of total billed charges,67% of total billed charges,85.91,71,,,percent of total billed charges,71% of total billed charges,91.96,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.88,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,108.9,90,,,percent of total billed charges,90% of total billed charges,108.9,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,107.21,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,96.8,80,,,percent of total billed charges,80% of total billed charges,96.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,110.11,91,,,percent of total billed charges,91% of total billed charges,39.49,32.64,,,percent of total billed charges,32.64% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,40.66,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,38.72,32,,,percent of total billed charges,32% of total billed charges,38.72,32,,,percent of total billed charges,32% of total billed charges,111.32,92,,,percent of total billed charges,92% of total billed charges,13.55,111.32,
BODY FLUID GLUCOSE,2001466,CDM,301,RC,82945,HCPCS,Outpatient,,,57,48.45,,46.28,81.2,,,percent of total billed charges,81.2% of total billed charges,18.6,32.64,,,percent of total billed charges,32.64% of total billed charges,42.18,74,,,percent of total billed charges,74% of total billed charges,42.18,74,,,percent of total billed charges,74% of total billed charges,18.24,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.24,32,,,percent of total billed charges,32% of total billed charges,40.47,71,,,percent of total billed charges,71% of total billed charges,40.47,71,,,percent of total billed charges,71% of total billed charges,38.19,67,,,percent of total billed charges,67% of total billed charges,38.19,67,,,percent of total billed charges,67% of total billed charges,40.47,71,,,percent of total billed charges,71% of total billed charges,43.32,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.79,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,51.3,90,,,percent of total billed charges,90% of total billed charges,51.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,50.5,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.24,32,,,percent of total billed charges,32% of total billed charges,45.6,80,,,percent of total billed charges,80% of total billed charges,45.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,51.87,91,,,percent of total billed charges,91% of total billed charges,18.6,32.64,,,percent of total billed charges,32.64% of total billed charges,18.24,32,,,percent of total billed charges,32% of total billed charges,19.15,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.24,32,,,percent of total billed charges,32% of total billed charges,18.24,32,,,percent of total billed charges,32% of total billed charges,52.44,92,,,percent of total billed charges,92% of total billed charges,7.24,52.44,
GLUCOSE SPINAL FLUID,2000407,CDM,301,RC,82945,HCPCS,Outpatient,,,57,48.45,,46.28,81.2,,,percent of total billed charges,81.2% of total billed charges,18.6,32.64,,,percent of total billed charges,32.64% of total billed charges,42.18,74,,,percent of total billed charges,74% of total billed charges,42.18,74,,,percent of total billed charges,74% of total billed charges,18.24,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.24,32,,,percent of total billed charges,32% of total billed charges,40.47,71,,,percent of total billed charges,71% of total billed charges,40.47,71,,,percent of total billed charges,71% of total billed charges,38.19,67,,,percent of total billed charges,67% of total billed charges,38.19,67,,,percent of total billed charges,67% of total billed charges,40.47,71,,,percent of total billed charges,71% of total billed charges,43.32,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.79,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,51.3,90,,,percent of total billed charges,90% of total billed charges,51.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,50.5,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.24,32,,,percent of total billed charges,32% of total billed charges,45.6,80,,,percent of total billed charges,80% of total billed charges,45.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,51.87,91,,,percent of total billed charges,91% of total billed charges,18.6,32.64,,,percent of total billed charges,32.64% of total billed charges,18.24,32,,,percent of total billed charges,32% of total billed charges,19.15,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,18.24,32,,,percent of total billed charges,32% of total billed charges,18.24,32,,,percent of total billed charges,32% of total billed charges,52.44,92,,,percent of total billed charges,92% of total billed charges,7.24,52.44,
2 HOUR PPBS,2000502,CDM,301,RC,82947,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,7.24,69,
GLUCOSE,2000067,CDM,301,RC,82947,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,7.24,69,
GLUCOSE TOLERANCE 1 HR,2000150,CDM,301,RC,82950,HCPCS,Outpatient,,,146,124.1,,118.55,81.2,,,percent of total billed charges,81.2% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,110.96,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,48.12,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,129.36,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,132.86,91,,,percent of total billed charges,91% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,49.06,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,134.32,92,,,percent of total billed charges,92% of total billed charges,7.24,134.32,
GLUCOSE TOLERANCE 2 HR,2001067,CDM,301,RC,82950,HCPCS,Outpatient,,,146,124.1,,118.55,81.2,,,percent of total billed charges,81.2% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,110.96,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,48.12,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,129.36,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,132.86,91,,,percent of total billed charges,91% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,49.06,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,134.32,92,,,percent of total billed charges,92% of total billed charges,7.24,134.32,
GLUCOSE TOLERANCE 3 HR,2000068,CDM,301,RC,82951,HCPCS,Outpatient,,,310,263.5,,251.72,81.2,,,percent of total billed charges,81.2% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,235.6,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,102.18,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,274.66,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,282.1,91,,,percent of total billed charges,91% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,104.16,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,285.2,92,,,percent of total billed charges,92% of total billed charges,11.18,285.2,
G6PD QUANTITATIVE,2000265,CDM,301,RC,82955,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,11.18,46,
FINGER STICK GLUCOSE,2001362,CDM,301,RC,82962,HCPCS,Outpatient,,,15,12.75,,12.18,81.2,,,percent of total billed charges,81.2% of total billed charges,4.9,32.64,,,percent of total billed charges,32.64% of total billed charges,11.1,74,,,percent of total billed charges,74% of total billed charges,11.1,74,,,percent of total billed charges,74% of total billed charges,4.8,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,4.8,32,,,percent of total billed charges,32% of total billed charges,10.65,71,,,percent of total billed charges,71% of total billed charges,10.65,71,,,percent of total billed charges,71% of total billed charges,10.05,67,,,percent of total billed charges,67% of total billed charges,10.05,67,,,percent of total billed charges,67% of total billed charges,10.65,71,,,percent of total billed charges,71% of total billed charges,11.4,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,4.94,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,13.5,90,,,percent of total billed charges,90% of total billed charges,13.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,13.29,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,4.8,32,,,percent of total billed charges,32% of total billed charges,12,80,,,percent of total billed charges,80% of total billed charges,12,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,13.65,91,,,percent of total billed charges,91% of total billed charges,4.9,32.64,,,percent of total billed charges,32.64% of total billed charges,4.8,32,,,percent of total billed charges,32% of total billed charges,5.04,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,4.8,32,,,percent of total billed charges,32% of total billed charges,4.8,32,,,percent of total billed charges,32% of total billed charges,13.8,92,,,percent of total billed charges,92% of total billed charges,4.8,13.8,
GGT,2000066,CDM,301,RC,82977,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
FOLLICLE STIM HORMONE FSH,2000164,CDM,301,RC,83001,HCPCS,Outpatient,,,94,79.9,,76.33,81.2,,,percent of total billed charges,81.2% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,71.44,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,30.98,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,84.6,90,,,percent of total billed charges,90% of total billed charges,84.6,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,83.28,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,85.54,91,,,percent of total billed charges,91% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,31.58,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,86.48,92,,,percent of total billed charges,92% of total billed charges,13.55,86.48,
LUTENIZING HORMONE LH,2000156,CDM,301,RC,83002,HCPCS,Outpatient,,,169,143.65,,137.23,81.2,,,percent of total billed charges,81.2% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,128.44,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,55.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,152.1,90,,,percent of total billed charges,90% of total billed charges,152.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,149.73,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,153.79,91,,,percent of total billed charges,91% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,56.78,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,155.48,92,,,percent of total billed charges,92% of total billed charges,13.55,155.48,
GROWTH HORMONE,2000675,CDM,301,RC,83003,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,13.55,41.4,
HAPTOGLOBIN,2000161,CDM,301,RC,83010,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,11.18,64.4,
H. PYLORI BREATH TEST,2001777,CDM,300,RC,83013,HCPCS,Outpatient,,,327,277.95,,265.52,81.2,,,percent of total billed charges,81.2% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,248.52,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,107.78,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,289.72,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,297.57,91,,,percent of total billed charges,91% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,109.87,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,300.84,92,,,percent of total billed charges,92% of total billed charges,12.85,300.84,
ELECTROPHORESIS HEMOGLOBIN,2000051,CDM,301,RC,83020,HCPCS,Outpatient,,,151,128.35,,122.61,81.2,,,percent of total billed charges,81.2% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,114.76,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,49.77,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,133.79,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,137.41,91,,,percent of total billed charges,91% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,50.74,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,138.92,92,,,percent of total billed charges,92% of total billed charges,11.18,138.92,
HEMOGLOBIN A1C GLYCOHEMOGL,2000071,CDM,301,RC,83036,HCPCS,Outpatient,,,82,69.7,,66.58,81.2,,,percent of total billed charges,81.2% of total billed charges,26.76,32.64,,,percent of total billed charges,32.64% of total billed charges,60.68,74,,,percent of total billed charges,74% of total billed charges,60.68,74,,,percent of total billed charges,74% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,54.94,67,,,percent of total billed charges,67% of total billed charges,54.94,67,,,percent of total billed charges,67% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,62.32,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.03,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,73.8,90,,,percent of total billed charges,90% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,72.65,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,65.6,80,,,percent of total billed charges,80% of total billed charges,65.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,74.62,91,,,percent of total billed charges,91% of total billed charges,26.76,32.64,,,percent of total billed charges,32.64% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,27.55,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,75.44,92,,,percent of total billed charges,92% of total billed charges,11.18,75.44,
"METHEMOGLOBIN - HGB, BLOOD",2001780,CDM,301,RC,83050,HCPCS,Outpatient,,,36,30.6,,29.23,81.2,,,percent of total billed charges,81.2% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,27.36,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,11.87,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,32.4,90,,,percent of total billed charges,90% of total billed charges,32.4,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,31.9,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,32.76,91,,,percent of total billed charges,91% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,12.1,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,33.12,92,,,percent of total billed charges,92% of total billed charges,7.24,33.12,
HOMOCYSTINE PLASMA,2000251,CDM,301,RC,83090,HCPCS,Outpatient,,,74,62.9,,60.09,81.2,,,percent of total billed charges,81.2% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,54.76,74,,,percent of total billed charges,74% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,23.68,32,,,percent of total billed charges,32% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,49.58,67,,,percent of total billed charges,67% of total billed charges,52.54,71,,,percent of total billed charges,71% of total billed charges,56.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,24.39,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,66.6,90,,,percent of total billed charges,90% of total billed charges,66.6,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,65.56,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,23.68,32,,,percent of total billed charges,32% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,59.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,67.34,91,,,percent of total billed charges,91% of total billed charges,24.15,32.64,,,percent of total billed charges,32.64% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,24.86,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,23.68,32,,,percent of total billed charges,32% of total billed charges,23.68,32,,,percent of total billed charges,32% of total billed charges,68.08,92,,,percent of total billed charges,92% of total billed charges,13.55,68.08,
HYDROXYPROGESTERONE 17 SERUM,2000449,CDM,301,RC,83498,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,13.55,74.52,
ALPHA GALACTOSE IGE,2001396,CDM,301,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
ANTI GLIADIN IGA,2001740,CDM,301,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
ANTI GLIADIN IGG,2000560,CDM,301,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
ANTI GLOMERULAR BASEMENT MEM.,2000607,CDM,301,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
ANTI MULLERIAN HORMONE,2001080,CDM,301,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
ANTI PS/PT ABS IGM,2001751,CDM,300,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
ANTI SMOOTH,2001016,CDM,300,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
ANTIRIBOSOMAL P ANTIBODY,2001333,CDM,301,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
GLUTEN SENSITIVITY CASCADE TEST,2001756,CDM,301,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
TISSUE TRANSGLUTAMINASE IGA ONLY,2001103,CDM,301,RC,83516,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,14.22,77.28,
21 HYDROXYLASE ANTIBODIES,2001028,CDM,300,RC,83519,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,14.22,205.16,
ACETYICHDINE MODULATING ANTIBODIES,2001452,CDM,301,RC,83519,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,14.22,205.16,
ACETYICHOLINE BLOCKING ANTIBODIES,2001453,CDM,301,RC,83519,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,14.22,205.16,
ACETYLCHOLINE BINDING RECEPTOR,2000650,CDM,300,RC,83519,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,14.22,205.16,
GAD ANTIBODY,2000895,CDM,300,RC,83519,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,14.22,205.16,
IMMUNO-REACTIVE TRYPSIONOGEN,2001229,CDM,301,RC,83519,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,14.22,205.16,
IgFBP 3,2000984,CDM,300,RC,83520,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,14.22,101.2,
PR3 ANTIBODIES,2001789,CDM,301,RC,83520,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,14.22,101.2,
RHEUMATOID ARTHRITIS,2001682,CDM,302,RC,83520,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,14.22,101.2,
THYROTROPIN RECEPTOR AB,2001186,CDM,301,RC,83520,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,14.22,101.2,
TRYPTASE,2000878,CDM,300,RC,83520,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,14.22,101.2,
TSH RECEPTOR ANTIBODY,2001511,CDM,301,RC,83520,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,14.22,101.2,
INSULIN TOTAL,2000090,CDM,301,RC,83525,HCPCS,Outpatient,,,39,33.15,,31.67,81.2,,,percent of total billed charges,81.2% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,29.64,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,12.85,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,34.55,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,35.49,91,,,percent of total billed charges,91% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,13.1,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,35.88,92,,,percent of total billed charges,92% of total billed charges,12.48,35.88,
INSULIN FREE AND TOTAL,2001111,CDM,301,RC,83527,HCPCS,Outpatient,,,38,32.3,,30.86,81.2,,,percent of total billed charges,81.2% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,28.88,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,12.52,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,34.2,90,,,percent of total billed charges,90% of total billed charges,34.2,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,33.67,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,34.58,91,,,percent of total billed charges,91% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,12.77,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,34.96,92,,,percent of total billed charges,92% of total billed charges,12.16,34.96,
IRON,2000093,CDM,301,RC,83540,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,7.24,85.56,
IRON BINDING CAPACITY (TIBC),2000092,CDM,301,RC,83550,HCPCS,Outpatient,,,96,81.6,,77.95,81.2,,,percent of total billed charges,81.2% of total billed charges,31.33,32.64,,,percent of total billed charges,32.64% of total billed charges,71.04,74,,,percent of total billed charges,74% of total billed charges,71.04,74,,,percent of total billed charges,74% of total billed charges,30.72,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.72,32,,,percent of total billed charges,32% of total billed charges,68.16,71,,,percent of total billed charges,71% of total billed charges,68.16,71,,,percent of total billed charges,71% of total billed charges,64.32,67,,,percent of total billed charges,67% of total billed charges,64.32,67,,,percent of total billed charges,67% of total billed charges,68.16,71,,,percent of total billed charges,71% of total billed charges,72.96,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,31.64,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,86.4,90,,,percent of total billed charges,90% of total billed charges,86.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,85.06,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.72,32,,,percent of total billed charges,32% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,76.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,87.36,91,,,percent of total billed charges,91% of total billed charges,31.33,32.64,,,percent of total billed charges,32.64% of total billed charges,30.72,32,,,percent of total billed charges,32% of total billed charges,32.26,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.72,32,,,percent of total billed charges,32% of total billed charges,30.72,32,,,percent of total billed charges,32% of total billed charges,88.32,92,,,percent of total billed charges,92% of total billed charges,11.18,88.32,
LACTIC ACID,2000158,CDM,301,RC,83605,HCPCS,Outpatient,,,46,39.1,,37.35,81.2,,,percent of total billed charges,81.2% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,34.96,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.16,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,41.4,90,,,percent of total billed charges,90% of total billed charges,41.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,40.76,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,41.86,91,,,percent of total billed charges,91% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,15.46,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,42.32,92,,,percent of total billed charges,92% of total billed charges,11.18,42.32,
BODY FLUID LDH,2001469,CDM,301,RC,83615,HCPCS,Outpatient,,,38,32.3,,30.86,81.2,,,percent of total billed charges,81.2% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,28.88,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,12.52,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,34.2,90,,,percent of total billed charges,90% of total billed charges,34.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,33.67,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,34.58,91,,,percent of total billed charges,91% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,12.77,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,34.96,92,,,percent of total billed charges,92% of total billed charges,7.24,34.96,
LDH / LDI,2000094,CDM,301,RC,83615,HCPCS,Outpatient,,,38,32.3,,30.86,81.2,,,percent of total billed charges,81.2% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,28.88,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,12.52,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,34.2,90,,,percent of total billed charges,90% of total billed charges,34.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,33.67,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,34.58,91,,,percent of total billed charges,91% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,12.77,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,34.96,92,,,percent of total billed charges,92% of total billed charges,7.24,34.96,
LDH ISOENZYMES,2000095,CDM,301,RC,83625,HCPCS,Outpatient,,,113,96.05,,91.76,81.2,,,percent of total billed charges,81.2% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,85.88,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,37.24,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,100.12,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,102.83,91,,,percent of total billed charges,91% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,37.97,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,103.96,92,,,percent of total billed charges,92% of total billed charges,11.18,103.96,
LACTOFERRIN,2000944,CDM,300,RC,83630,HCPCS,Outpatient,,,106,90.1,,86.07,81.2,,,percent of total billed charges,81.2% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,80.56,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.94,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,93.92,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,96.46,91,,,percent of total billed charges,91% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,35.62,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.92,32,,,percent of total billed charges,32% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,97.52,92,,,percent of total billed charges,92% of total billed charges,11.18,97.52,
LEAD 24 URINE,2001744,CDM,300,RC,83655,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,9.98,95.68,
LEAD ADULT,2001097,CDM,301,RC,83655,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,9.98,95.68,
LEAD PED - CAPILLARY,2001836,CDM,301,RC,83655,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,9.98,95.68,
LEAD PEDIATRIC,2000096,CDM,301,RC,83655,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,9.98,95.68,
LIPASE,2000475,CDM,301,RC,83690,HCPCS,Outpatient,,,78,66.3,,63.34,81.2,,,percent of total billed charges,81.2% of total billed charges,25.46,32.64,,,percent of total billed charges,32.64% of total billed charges,57.72,74,,,percent of total billed charges,74% of total billed charges,57.72,74,,,percent of total billed charges,74% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,52.26,67,,,percent of total billed charges,67% of total billed charges,52.26,67,,,percent of total billed charges,67% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,59.28,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.71,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,70.2,90,,,percent of total billed charges,90% of total billed charges,70.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,69.11,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,62.4,80,,,percent of total billed charges,80% of total billed charges,62.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.98,91,,,percent of total billed charges,91% of total billed charges,25.46,32.64,,,percent of total billed charges,32.64% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,26.21,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,71.76,92,,,percent of total billed charges,92% of total billed charges,7.24,71.76,
LIPOPROTEIN A,2000542,CDM,301,RC,83695,HCPCS,Outpatient,,,195,165.75,,158.34,81.2,,,percent of total billed charges,81.2% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,148.2,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,64.27,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,172.77,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,177.45,91,,,percent of total billed charges,91% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,65.52,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,179.4,92,,,percent of total billed charges,92% of total billed charges,11.18,179.4,
NMR,2000842,CDM,300,RC,83704,HCPCS,Outpatient,,,151,128.35,,122.61,81.2,,,percent of total billed charges,81.2% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,114.76,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,49.77,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,133.79,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,137.41,91,,,percent of total billed charges,91% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,50.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,138.92,92,,,percent of total billed charges,92% of total billed charges,12.85,138.92,
DIRECT LDL CHOLESTEROL,2000720,CDM,300,RC,83721,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,11.18,64.4,
GONADOTROPIN-RELEASING HORMONE,2001312,CDM,301,RC,83727,HCPCS,Outpatient,,,411,349.35,,333.73,81.2,,,percent of total billed charges,81.2% of total billed charges,134.15,32.64,,,percent of total billed charges,32.64% of total billed charges,304.14,74,,,percent of total billed charges,74% of total billed charges,304.14,74,,,percent of total billed charges,74% of total billed charges,131.52,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,131.52,32,,,percent of total billed charges,32% of total billed charges,291.81,71,,,percent of total billed charges,71% of total billed charges,291.81,71,,,percent of total billed charges,71% of total billed charges,275.37,67,,,percent of total billed charges,67% of total billed charges,275.37,67,,,percent of total billed charges,67% of total billed charges,291.81,71,,,percent of total billed charges,71% of total billed charges,312.36,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,135.47,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,369.9,90,,,percent of total billed charges,90% of total billed charges,369.9,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,364.15,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,131.52,32,,,percent of total billed charges,32% of total billed charges,328.8,80,,,percent of total billed charges,80% of total billed charges,328.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,374.01,91,,,percent of total billed charges,91% of total billed charges,134.15,32.64,,,percent of total billed charges,32.64% of total billed charges,131.52,32,,,percent of total billed charges,32% of total billed charges,138.1,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,131.52,32,,,percent of total billed charges,32% of total billed charges,131.52,32,,,percent of total billed charges,32% of total billed charges,378.12,92,,,percent of total billed charges,92% of total billed charges,13.55,378.12,
MAGNESIUM,2000100,CDM,301,RC,83735,HCPCS,Outpatient,,,42,35.7,,34.1,81.2,,,percent of total billed charges,81.2% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,31.92,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.84,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,37.21,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,38.22,91,,,percent of total billed charges,91% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,14.11,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,38.64,92,,,percent of total billed charges,92% of total billed charges,7.24,38.64,
MAGNESIUM URINE 24 HOUR,2000157,CDM,301,RC,83735,HCPCS,Outpatient,,,42,35.7,,34.1,81.2,,,percent of total billed charges,81.2% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,31.92,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.84,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,37.21,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,38.22,91,,,percent of total billed charges,91% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,14.11,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,38.64,92,,,percent of total billed charges,92% of total billed charges,7.24,38.64,
RBC MAGNESIUM,2001357,CDM,301,RC,83735,HCPCS,Outpatient,,,42,35.7,,34.1,81.2,,,percent of total billed charges,81.2% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,31.92,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.84,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,37.21,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,38.22,91,,,percent of total billed charges,91% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,14.11,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,38.64,92,,,percent of total billed charges,92% of total billed charges,7.24,38.64,
IODINE BLOOD,2001051,CDM,300,RC,83789,HCPCS,Outpatient,,,89,75.65,,72.27,81.2,,,percent of total billed charges,81.2% of total billed charges,29.05,32.64,,,percent of total billed charges,32.64% of total billed charges,65.86,74,,,percent of total billed charges,74% of total billed charges,65.86,74,,,percent of total billed charges,74% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,59.63,67,,,percent of total billed charges,67% of total billed charges,59.63,67,,,percent of total billed charges,67% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,67.64,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.33,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,80.1,90,,,percent of total billed charges,90% of total billed charges,80.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,78.85,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,71.2,80,,,percent of total billed charges,80% of total billed charges,71.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,80.99,91,,,percent of total billed charges,91% of total billed charges,29.05,32.64,,,percent of total billed charges,32.64% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,29.9,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,81.88,92,,,percent of total billed charges,92% of total billed charges,11.18,81.88,
MERCURY 24 URINE,2001746,CDM,300,RC,83825,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,9.98,93.84,
MERCURY BLOOD,2000162,CDM,300,RC,83825,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,9.98,93.84,
METANEPHRINES 24HR URINE QUAN,2000102,CDM,301,RC,83835,HCPCS,Outpatient,,,151,128.35,,122.61,81.2,,,percent of total billed charges,81.2% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,114.76,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,49.77,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,133.79,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,137.41,91,,,percent of total billed charges,91% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,50.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,138.92,92,,,percent of total billed charges,92% of total billed charges,13.55,138.92,
METANEPHRINES PLASMA,2000561,CDM,301,RC,83835,HCPCS,Outpatient,,,151,128.35,,122.61,81.2,,,percent of total billed charges,81.2% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,114.76,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,49.77,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,133.79,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,137.41,91,,,percent of total billed charges,91% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,50.74,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,138.92,92,,,percent of total billed charges,92% of total billed charges,13.55,138.92,
MYELIN BASIC PROTEIN,2000676,CDM,301,RC,83873,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,11.18,64.4,
MYOGLOBIN  URINE,2000835,CDM,300,RC,83874,HCPCS,Outpatient,,,68,57.8,,55.22,81.2,,,percent of total billed charges,81.2% of total billed charges,22.2,32.64,,,percent of total billed charges,32.64% of total billed charges,50.32,74,,,percent of total billed charges,74% of total billed charges,50.32,74,,,percent of total billed charges,74% of total billed charges,21.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.76,32,,,percent of total billed charges,32% of total billed charges,48.28,71,,,percent of total billed charges,71% of total billed charges,48.28,71,,,percent of total billed charges,71% of total billed charges,45.56,67,,,percent of total billed charges,67% of total billed charges,45.56,67,,,percent of total billed charges,67% of total billed charges,48.28,71,,,percent of total billed charges,71% of total billed charges,51.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.41,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,61.2,90,,,percent of total billed charges,90% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,60.25,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.76,32,,,percent of total billed charges,32% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,61.88,91,,,percent of total billed charges,91% of total billed charges,22.2,32.64,,,percent of total billed charges,32.64% of total billed charges,21.76,32,,,percent of total billed charges,32% of total billed charges,22.85,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.76,32,,,percent of total billed charges,32% of total billed charges,21.76,32,,,percent of total billed charges,32% of total billed charges,62.56,92,,,percent of total billed charges,92% of total billed charges,11.18,62.56,
MYOGLOBIN SERUM,2000344,CDM,301,RC,83874,HCPCS,Outpatient,,,68,57.8,,55.22,81.2,,,percent of total billed charges,81.2% of total billed charges,22.2,32.64,,,percent of total billed charges,32.64% of total billed charges,50.32,74,,,percent of total billed charges,74% of total billed charges,50.32,74,,,percent of total billed charges,74% of total billed charges,21.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.76,32,,,percent of total billed charges,32% of total billed charges,48.28,71,,,percent of total billed charges,71% of total billed charges,48.28,71,,,percent of total billed charges,71% of total billed charges,45.56,67,,,percent of total billed charges,67% of total billed charges,45.56,67,,,percent of total billed charges,67% of total billed charges,48.28,71,,,percent of total billed charges,71% of total billed charges,51.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.41,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,61.2,90,,,percent of total billed charges,90% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,60.25,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.76,32,,,percent of total billed charges,32% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,54.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,61.88,91,,,percent of total billed charges,91% of total billed charges,22.2,32.64,,,percent of total billed charges,32.64% of total billed charges,21.76,32,,,percent of total billed charges,32% of total billed charges,22.85,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.76,32,,,percent of total billed charges,32% of total billed charges,21.76,32,,,percent of total billed charges,32% of total billed charges,62.56,92,,,percent of total billed charges,92% of total billed charges,11.18,62.56,
B TYPE NATRIURETIC PEPTIDE,2000653,CDM,301,RC,83880,HCPCS,Outpatient,,,232,197.2,,188.38,81.2,,,percent of total billed charges,81.2% of total billed charges,75.72,32.64,,,percent of total billed charges,32.64% of total billed charges,171.68,74,,,percent of total billed charges,74% of total billed charges,171.68,74,,,percent of total billed charges,74% of total billed charges,74.24,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,74.24,32,,,percent of total billed charges,32% of total billed charges,164.72,71,,,percent of total billed charges,71% of total billed charges,164.72,71,,,percent of total billed charges,71% of total billed charges,155.44,67,,,percent of total billed charges,67% of total billed charges,155.44,67,,,percent of total billed charges,67% of total billed charges,164.72,71,,,percent of total billed charges,71% of total billed charges,176.32,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,76.47,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,208.8,90,,,percent of total billed charges,90% of total billed charges,208.8,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,205.55,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,74.24,32,,,percent of total billed charges,32% of total billed charges,185.6,80,,,percent of total billed charges,80% of total billed charges,185.6,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,211.12,91,,,percent of total billed charges,91% of total billed charges,75.72,32.64,,,percent of total billed charges,32.64% of total billed charges,74.24,32,,,percent of total billed charges,32% of total billed charges,77.95,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,74.24,32,,,percent of total billed charges,32% of total billed charges,74.24,32,,,percent of total billed charges,32% of total billed charges,213.44,92,,,percent of total billed charges,92% of total billed charges,12.85,213.44,
ALPHA 2 MACROGLOBULIN,2001398,CDM,301,RC,83883,HCPCS,Outpatient,,,230,195.5,,186.76,81.2,,,percent of total billed charges,81.2% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,174.8,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,75.81,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,203.78,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,209.3,91,,,percent of total billed charges,91% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,77.28,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,211.6,92,,,percent of total billed charges,92% of total billed charges,14.22,211.6,
"FREE LIGHT CHAINS,SERUM",2000997,CDM,300,RC,83883,HCPCS,Outpatient,,,230,195.5,,186.76,81.2,,,percent of total billed charges,81.2% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,174.8,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,75.81,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,203.78,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,209.3,91,,,percent of total billed charges,91% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,77.28,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,211.6,92,,,percent of total billed charges,92% of total billed charges,14.22,211.6,
OLIOGCLONAL BANDING,2000677,CDM,301,RC,83916,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,11.18,85.56,
"ORGANIC ACID, QUAL PROFILE",2001231,CDM,301,RC,83918,HCPCS,Outpatient,,,153,130.05,,124.24,81.2,,,percent of total billed charges,81.2% of total billed charges,49.94,32.64,,,percent of total billed charges,32.64% of total billed charges,113.22,74,,,percent of total billed charges,74% of total billed charges,113.22,74,,,percent of total billed charges,74% of total billed charges,48.96,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,48.96,32,,,percent of total billed charges,32% of total billed charges,108.63,71,,,percent of total billed charges,71% of total billed charges,108.63,71,,,percent of total billed charges,71% of total billed charges,102.51,67,,,percent of total billed charges,67% of total billed charges,102.51,67,,,percent of total billed charges,67% of total billed charges,108.63,71,,,percent of total billed charges,71% of total billed charges,116.28,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,50.43,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,137.7,90,,,percent of total billed charges,90% of total billed charges,137.7,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,135.56,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,48.96,32,,,percent of total billed charges,32% of total billed charges,122.4,80,,,percent of total billed charges,80% of total billed charges,122.4,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,139.23,91,,,percent of total billed charges,91% of total billed charges,49.94,32.64,,,percent of total billed charges,32.64% of total billed charges,48.96,32,,,percent of total billed charges,32% of total billed charges,51.41,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,48.96,32,,,percent of total billed charges,32% of total billed charges,48.96,32,,,percent of total billed charges,32% of total billed charges,140.76,92,,,percent of total billed charges,92% of total billed charges,9.98,140.76,
METHYLMALONIC ACID SERUM QUANT,2000558,CDM,301,RC,83921,HCPCS,Outpatient,,,162,137.7,,131.54,81.2,,,percent of total billed charges,81.2% of total billed charges,52.88,32.64,,,percent of total billed charges,32.64% of total billed charges,119.88,74,,,percent of total billed charges,74% of total billed charges,119.88,74,,,percent of total billed charges,74% of total billed charges,51.84,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,51.84,32,,,percent of total billed charges,32% of total billed charges,115.02,71,,,percent of total billed charges,71% of total billed charges,115.02,71,,,percent of total billed charges,71% of total billed charges,108.54,67,,,percent of total billed charges,67% of total billed charges,108.54,67,,,percent of total billed charges,67% of total billed charges,115.02,71,,,percent of total billed charges,71% of total billed charges,123.12,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,53.4,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,145.8,90,,,percent of total billed charges,90% of total billed charges,145.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,143.53,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,51.84,32,,,percent of total billed charges,32% of total billed charges,129.6,80,,,percent of total billed charges,80% of total billed charges,129.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,147.42,91,,,percent of total billed charges,91% of total billed charges,52.88,32.64,,,percent of total billed charges,32.64% of total billed charges,51.84,32,,,percent of total billed charges,32% of total billed charges,54.43,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,51.84,32,,,percent of total billed charges,32% of total billed charges,51.84,32,,,percent of total billed charges,32% of total billed charges,149.04,92,,,percent of total billed charges,92% of total billed charges,11.18,149.04,
OSMOLALITY BLOOD,2000105,CDM,301,RC,83930,HCPCS,Outpatient,,,113,96.05,,91.76,81.2,,,percent of total billed charges,81.2% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,85.88,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,37.24,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,100.12,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,102.83,91,,,percent of total billed charges,91% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,37.97,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,103.96,92,,,percent of total billed charges,92% of total billed charges,7.24,103.96,
URINE OSMOLALITY,2000106,CDM,301,RC,83935,HCPCS,Outpatient,,,113,96.05,,91.76,81.2,,,percent of total billed charges,81.2% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,85.88,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,37.24,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,100.12,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,102.83,91,,,percent of total billed charges,91% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,37.97,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,103.96,92,,,percent of total billed charges,92% of total billed charges,7.24,103.96,
OXALATE URINE 24 HOUR,2000300,CDM,301,RC,83945,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,11.18,79.12,
PARATHORMONE N,2000108,CDM,301,RC,83970,HCPCS,Outpatient,,,270,229.5,,219.24,81.2,,,percent of total billed charges,81.2% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,205.2,76,,,percent of total billed charges,76% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,88.99,32.96,,,percent of total billed charges,32.96% of total billed charges,17.91,105,,,Fee Schedule,pays based on EAPG rates,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,239.22,88.6,,,percent of total billed charges,88.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,245.7,91,,,percent of total billed charges,91% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,90.72,33.6,,,percent of total billed charges,33.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,248.4,92,,,percent of total billed charges,92% of total billed charges,17.05,248.4,
CALPROTECTIN,2001025,CDM,300,RC,83993,HCPCS,Outpatient,,,329,279.65,,267.15,81.2,,,percent of total billed charges,81.2% of total billed charges,107.39,32.64,,,percent of total billed charges,32.64% of total billed charges,243.46,74,,,percent of total billed charges,74% of total billed charges,243.46,74,,,percent of total billed charges,74% of total billed charges,105.28,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.28,32,,,percent of total billed charges,32% of total billed charges,233.59,71,,,percent of total billed charges,71% of total billed charges,233.59,71,,,percent of total billed charges,71% of total billed charges,220.43,67,,,percent of total billed charges,67% of total billed charges,220.43,67,,,percent of total billed charges,67% of total billed charges,233.59,71,,,percent of total billed charges,71% of total billed charges,250.04,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,108.44,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,296.1,90,,,percent of total billed charges,90% of total billed charges,296.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,291.49,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.28,32,,,percent of total billed charges,32% of total billed charges,263.2,80,,,percent of total billed charges,80% of total billed charges,263.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,299.39,91,,,percent of total billed charges,91% of total billed charges,107.39,32.64,,,percent of total billed charges,32.64% of total billed charges,105.28,32,,,percent of total billed charges,32% of total billed charges,110.54,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,105.28,32,,,percent of total billed charges,32% of total billed charges,105.28,32,,,percent of total billed charges,32% of total billed charges,302.68,92,,,percent of total billed charges,92% of total billed charges,11.18,302.68,
ALKALINE PHOSPHATASE,2000009,CDM,301,RC,84075,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
ALK PHOS ISOENZYME,2000845,CDM,300,RC,84080,HCPCS,Outpatient,,,147,124.95,,119.36,81.2,,,percent of total billed charges,81.2% of total billed charges,47.98,32.64,,,percent of total billed charges,32.64% of total billed charges,108.78,74,,,percent of total billed charges,74% of total billed charges,108.78,74,,,percent of total billed charges,74% of total billed charges,47.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,47.04,32,,,percent of total billed charges,32% of total billed charges,104.37,71,,,percent of total billed charges,71% of total billed charges,104.37,71,,,percent of total billed charges,71% of total billed charges,98.49,67,,,percent of total billed charges,67% of total billed charges,98.49,67,,,percent of total billed charges,67% of total billed charges,104.37,71,,,percent of total billed charges,71% of total billed charges,111.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,48.45,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,132.3,90,,,percent of total billed charges,90% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,130.24,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,47.04,32,,,percent of total billed charges,32% of total billed charges,117.6,80,,,percent of total billed charges,80% of total billed charges,117.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,133.77,91,,,percent of total billed charges,91% of total billed charges,47.98,32.64,,,percent of total billed charges,32.64% of total billed charges,47.04,32,,,percent of total billed charges,32% of total billed charges,49.39,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,47.04,32,,,percent of total billed charges,32% of total billed charges,47.04,32,,,percent of total billed charges,32% of total billed charges,135.24,92,,,percent of total billed charges,92% of total billed charges,11.18,135.24,
PHOSPHORUS,2000110,CDM,301,RC,84100,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
PHOSPHORUS URINE 24 HOUR,2000198,CDM,301,RC,84105,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,7.24,41.4,
PORPHOBILINOGEN  RANDOM URINE,2000345,CDM,301,RC,84110,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,11.18,39.56,
AMNISURE,2000983,CDM,300,RC,84112,HCPCS,Outpatient,,,137,116.45,,111.24,81.2,,,percent of total billed charges,81.2% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,104.12,76,,,percent of total billed charges,76% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,45.16,32.96,,,percent of total billed charges,32.96% of total billed charges,13.49,105,,,Fee Schedule,pays based on EAPG rates,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,121.38,88.6,,,percent of total billed charges,88.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,12.85,100,,,Fee Schedule,pays based on EAPG rates,124.67,91,,,percent of total billed charges,91% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,46.03,33.6,,,percent of total billed charges,33.6% of total billed charges,13.24,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,126.04,92,,,percent of total billed charges,92% of total billed charges,12.85,126.04,
URINE PORPHYRINS  RANDOM,2000199,CDM,301,RC,84120,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,11.18,64.4,
POTASSIUM,2000116,CDM,301,RC,84132,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,7.24,44.16,
POTASSIUM URINE,2000340,CDM,301,RC,84133,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,7.24,44.16,
POTASSIUM URINE 24,2000836,CDM,300,RC,84133,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,7.24,44.16,
PRE-ALBUMIN,2000568,CDM,301,RC,84134,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,11.18,44.16,
17-HYDROXYPREGNENOLONE MS,2001193,CDM,301,RC,84143,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,13.55,112.24,
PROGESTERONE SERUM,2000196,CDM,301,RC,84144,HCPCS,Outpatient,,,108,91.8,,87.7,81.2,,,percent of total billed charges,81.2% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,82.08,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.6,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,95.69,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,98.28,91,,,percent of total billed charges,91% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,36.29,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,99.36,92,,,percent of total billed charges,92% of total billed charges,13.55,99.36,
PROCALCITONIN,2001792,CDM,300,RC,84145,HCPCS,Outpatient,,,218,185.3,,177.02,81.2,,,percent of total billed charges,81.2% of total billed charges,71.16,32.64,,,percent of total billed charges,32.64% of total billed charges,161.32,74,,,percent of total billed charges,74% of total billed charges,161.32,74,,,percent of total billed charges,74% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,146.06,67,,,percent of total billed charges,67% of total billed charges,146.06,67,,,percent of total billed charges,67% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,165.68,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,71.85,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,196.2,90,,,percent of total billed charges,90% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,193.15,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,174.4,80,,,percent of total billed charges,80% of total billed charges,174.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,198.38,91,,,percent of total billed charges,91% of total billed charges,71.16,32.64,,,percent of total billed charges,32.64% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,73.25,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,200.56,92,,,percent of total billed charges,92% of total billed charges,13.55,200.56,
BETA 2 GLYCOPROTEIN IGA,2001680,CDM,300,RC,84146,HCPCS,Outpatient,,,149,126.65,,120.99,81.2,,,percent of total billed charges,81.2% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,113.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,49.11,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,132.01,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,135.59,91,,,percent of total billed charges,91% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,50.06,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,137.08,92,,,percent of total billed charges,92% of total billed charges,13.55,137.08,
PROLACTIN,2000197,CDM,301,RC,84146,HCPCS,Outpatient,,,149,126.65,,120.99,81.2,,,percent of total billed charges,81.2% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,113.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,49.11,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,132.01,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,135.59,91,,,percent of total billed charges,91% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,50.06,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,137.08,92,,,percent of total billed charges,92% of total billed charges,13.55,137.08,
PSA DIAGNOSTIC,2001055,CDM,301,RC,84153,HCPCS,Outpatient,,,173,147.05,,140.48,81.2,,,percent of total billed charges,81.2% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,131.48,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,57.02,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,155.7,90,,,percent of total billed charges,90% of total billed charges,155.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,153.28,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,157.43,91,,,percent of total billed charges,91% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,58.13,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,159.16,92,,,percent of total billed charges,92% of total billed charges,11.18,159.16,
PSA SCREENING,2000588,CDM,301,RC,84153,HCPCS,Outpatient,,,173,147.05,,140.48,81.2,,,percent of total billed charges,81.2% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,131.48,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,57.02,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,155.7,90,,,percent of total billed charges,90% of total billed charges,155.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,153.28,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,157.43,91,,,percent of total billed charges,91% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,58.13,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,159.16,92,,,percent of total billed charges,92% of total billed charges,11.18,159.16,
PSA FREE (INCLUDES TOTAL),2000514,CDM,301,RC,84154,HCPCS,Outpatient,,,143,121.55,,116.12,81.2,,,percent of total billed charges,81.2% of total billed charges,46.68,32.64,,,percent of total billed charges,32.64% of total billed charges,105.82,74,,,percent of total billed charges,74% of total billed charges,105.82,74,,,percent of total billed charges,74% of total billed charges,45.76,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.76,32,,,percent of total billed charges,32% of total billed charges,101.53,71,,,percent of total billed charges,71% of total billed charges,101.53,71,,,percent of total billed charges,71% of total billed charges,95.81,67,,,percent of total billed charges,67% of total billed charges,95.81,67,,,percent of total billed charges,67% of total billed charges,101.53,71,,,percent of total billed charges,71% of total billed charges,108.68,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,47.13,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,128.7,90,,,percent of total billed charges,90% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,126.7,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.76,32,,,percent of total billed charges,32% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,114.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,130.13,91,,,percent of total billed charges,91% of total billed charges,46.68,32.64,,,percent of total billed charges,32.64% of total billed charges,45.76,32,,,percent of total billed charges,32% of total billed charges,48.05,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.76,32,,,percent of total billed charges,32% of total billed charges,45.76,32,,,percent of total billed charges,32% of total billed charges,131.56,92,,,percent of total billed charges,92% of total billed charges,11.18,131.56,
TOTAL PROTEIN,2000141,CDM,301,RC,84155,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,7.24,69,
24 HR URINE PROTEIN,2001062,CDM,301,RC,84156,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,7.24,64.4,
URINE RANDOM PROTEIN,2000347,CDM,301,RC,84156,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,7.24,64.4,
BODY FLUID PROTEIN,2001467,CDM,301,RC,84157,HCPCS,Outpatient,,,33,28.05,,26.8,81.2,,,percent of total billed charges,81.2% of total billed charges,10.77,32.64,,,percent of total billed charges,32.64% of total billed charges,24.42,74,,,percent of total billed charges,74% of total billed charges,24.42,74,,,percent of total billed charges,74% of total billed charges,10.56,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,10.56,32,,,percent of total billed charges,32% of total billed charges,23.43,71,,,percent of total billed charges,71% of total billed charges,23.43,71,,,percent of total billed charges,71% of total billed charges,22.11,67,,,percent of total billed charges,67% of total billed charges,22.11,67,,,percent of total billed charges,67% of total billed charges,23.43,71,,,percent of total billed charges,71% of total billed charges,25.08,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,10.88,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,29.7,90,,,percent of total billed charges,90% of total billed charges,29.7,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,29.24,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,10.56,32,,,percent of total billed charges,32% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,30.03,91,,,percent of total billed charges,91% of total billed charges,10.77,32.64,,,percent of total billed charges,32.64% of total billed charges,10.56,32,,,percent of total billed charges,32% of total billed charges,11.09,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,10.56,32,,,percent of total billed charges,32% of total billed charges,10.56,32,,,percent of total billed charges,32% of total billed charges,30.36,92,,,percent of total billed charges,92% of total billed charges,7.24,30.36,
PROTEIN SPINAL FLUID,2000331,CDM,301,RC,84157,HCPCS,Outpatient,,,33,28.05,,26.8,81.2,,,percent of total billed charges,81.2% of total billed charges,10.77,32.64,,,percent of total billed charges,32.64% of total billed charges,24.42,74,,,percent of total billed charges,74% of total billed charges,24.42,74,,,percent of total billed charges,74% of total billed charges,10.56,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,10.56,32,,,percent of total billed charges,32% of total billed charges,23.43,71,,,percent of total billed charges,71% of total billed charges,23.43,71,,,percent of total billed charges,71% of total billed charges,22.11,67,,,percent of total billed charges,67% of total billed charges,22.11,67,,,percent of total billed charges,67% of total billed charges,23.43,71,,,percent of total billed charges,71% of total billed charges,25.08,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,10.88,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,29.7,90,,,percent of total billed charges,90% of total billed charges,29.7,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,29.24,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,10.56,32,,,percent of total billed charges,32% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,26.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,30.03,91,,,percent of total billed charges,91% of total billed charges,10.77,32.64,,,percent of total billed charges,32.64% of total billed charges,10.56,32,,,percent of total billed charges,32% of total billed charges,11.09,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,10.56,32,,,percent of total billed charges,32% of total billed charges,10.56,32,,,percent of total billed charges,32% of total billed charges,30.36,92,,,percent of total billed charges,92% of total billed charges,7.24,30.36,
ELECTROPHORESIS PROTEIN SERUM,2000052,CDM,301,RC,84165,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,11.18,44.16,
"ELECTROPHORESIS PROTEIN URINE,RANDOM",2000053,CDM,301,RC,84166,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,11.18,69,
PROTEIN ELECTROPHORESIS 24 HOUR URINE,2001100,CDM,301,RC,84166,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,11.18,69,
PROINSULIN,2000674,CDM,301,RC,84206,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,13.55,74.52,
VITAMIN B6,2000557,CDM,301,RC,84207,HCPCS,Outpatient,,,94,79.9,,76.33,81.2,,,percent of total billed charges,81.2% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,71.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.98,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,84.6,90,,,percent of total billed charges,90% of total billed charges,84.6,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,83.28,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,85.54,91,,,percent of total billed charges,91% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,31.58,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,86.48,92,,,percent of total billed charges,92% of total billed charges,11.18,86.48,
RENIN,2000279,CDM,301,RC,84244,HCPCS,Outpatient,,,195,165.75,,158.34,81.2,,,percent of total billed charges,81.2% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,148.2,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,64.27,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,172.77,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,177.45,91,,,percent of total billed charges,91% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,65.52,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,179.4,92,,,percent of total billed charges,92% of total billed charges,13.55,179.4,
RENIN RATIO,2001064,CDM,301,RC,84244,HCPCS,Outpatient,,,195,165.75,,158.34,81.2,,,percent of total billed charges,81.2% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,148.2,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,64.27,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,172.77,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,177.45,91,,,percent of total billed charges,91% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,65.52,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,179.4,92,,,percent of total billed charges,92% of total billed charges,13.55,179.4,
VITAMIN B2 RIBOFLAVIN,2000282,CDM,301,RC,84252,HCPCS,Outpatient,,,129,109.65,,104.75,81.2,,,percent of total billed charges,81.2% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,98.04,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,42.52,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,116.1,90,,,percent of total billed charges,90% of total billed charges,116.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,114.29,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,117.39,91,,,percent of total billed charges,91% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,43.34,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,118.68,92,,,percent of total billed charges,92% of total billed charges,11.18,118.68,
SELENIUM,2000513,CDM,301,RC,84255,HCPCS,Outpatient,,,270,229.5,,219.24,81.2,,,percent of total billed charges,81.2% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,205.2,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,88.99,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,239.22,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,245.7,91,,,percent of total billed charges,91% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,90.72,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,248.4,92,,,percent of total billed charges,92% of total billed charges,11.18,248.4,
SEROTONIN SERUM,2000416,CDM,301,RC,84260,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,13.55,93.84,
SEX HORMONE BINDING GLOBULIN,2000505,CDM,301,RC,84270,HCPCS,Outpatient,,,198,168.3,,160.78,81.2,,,percent of total billed charges,81.2% of total billed charges,64.63,32.64,,,percent of total billed charges,32.64% of total billed charges,146.52,74,,,percent of total billed charges,74% of total billed charges,146.52,74,,,percent of total billed charges,74% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,132.66,67,,,percent of total billed charges,67% of total billed charges,132.66,67,,,percent of total billed charges,67% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,150.48,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,65.26,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,178.2,90,,,percent of total billed charges,90% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,175.43,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,158.4,80,,,percent of total billed charges,80% of total billed charges,158.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,180.18,91,,,percent of total billed charges,91% of total billed charges,64.63,32.64,,,percent of total billed charges,32.64% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,66.53,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,182.16,92,,,percent of total billed charges,92% of total billed charges,11.18,182.16,
SODIUM,2000131,CDM,301,RC,84295,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,7.24,44.16,
SODIUM RANDOM URINE,2000354,CDM,301,RC,84300,HCPCS,Outpatient,,,80,68,,64.96,81.2,,,percent of total billed charges,81.2% of total billed charges,26.11,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,74,,,percent of total billed charges,74% of total billed charges,59.2,74,,,percent of total billed charges,74% of total billed charges,25.6,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.6,32,,,percent of total billed charges,32% of total billed charges,56.8,71,,,percent of total billed charges,71% of total billed charges,56.8,71,,,percent of total billed charges,71% of total billed charges,53.6,67,,,percent of total billed charges,67% of total billed charges,53.6,67,,,percent of total billed charges,67% of total billed charges,56.8,71,,,percent of total billed charges,71% of total billed charges,60.8,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,26.37,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,72,90,,,percent of total billed charges,90% of total billed charges,72,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.88,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.6,32,,,percent of total billed charges,32% of total billed charges,64,80,,,percent of total billed charges,80% of total billed charges,64,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,72.8,91,,,percent of total billed charges,91% of total billed charges,26.11,32.64,,,percent of total billed charges,32.64% of total billed charges,25.6,32,,,percent of total billed charges,32% of total billed charges,26.88,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.6,32,,,percent of total billed charges,32% of total billed charges,25.6,32,,,percent of total billed charges,32% of total billed charges,73.6,92,,,percent of total billed charges,92% of total billed charges,7.24,73.6,
SODIUM URINE 24 HR,2000539,CDM,301,RC,84300,HCPCS,Outpatient,,,80,68,,64.96,81.2,,,percent of total billed charges,81.2% of total billed charges,26.11,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,74,,,percent of total billed charges,74% of total billed charges,59.2,74,,,percent of total billed charges,74% of total billed charges,25.6,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.6,32,,,percent of total billed charges,32% of total billed charges,56.8,71,,,percent of total billed charges,71% of total billed charges,56.8,71,,,percent of total billed charges,71% of total billed charges,53.6,67,,,percent of total billed charges,67% of total billed charges,53.6,67,,,percent of total billed charges,67% of total billed charges,56.8,71,,,percent of total billed charges,71% of total billed charges,60.8,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,26.37,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,72,90,,,percent of total billed charges,90% of total billed charges,72,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.88,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.6,32,,,percent of total billed charges,32% of total billed charges,64,80,,,percent of total billed charges,80% of total billed charges,64,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,72.8,91,,,percent of total billed charges,91% of total billed charges,26.11,32.64,,,percent of total billed charges,32.64% of total billed charges,25.6,32,,,percent of total billed charges,32% of total billed charges,26.88,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.6,32,,,percent of total billed charges,32% of total billed charges,25.6,32,,,percent of total billed charges,32% of total billed charges,73.6,92,,,percent of total billed charges,92% of total billed charges,7.24,73.6,
INSULIN LIKE GROWTH FACTOR I,2000790,CDM,300,RC,84305,HCPCS,Outpatient,,,115,97.75,,93.38,81.2,,,percent of total billed charges,81.2% of total billed charges,37.54,32.64,,,percent of total billed charges,32.64% of total billed charges,85.1,74,,,percent of total billed charges,74% of total billed charges,85.1,74,,,percent of total billed charges,74% of total billed charges,36.8,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,36.8,32,,,percent of total billed charges,32% of total billed charges,81.65,71,,,percent of total billed charges,71% of total billed charges,81.65,71,,,percent of total billed charges,71% of total billed charges,77.05,67,,,percent of total billed charges,67% of total billed charges,77.05,67,,,percent of total billed charges,67% of total billed charges,81.65,71,,,percent of total billed charges,71% of total billed charges,87.4,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,37.9,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,103.5,90,,,percent of total billed charges,90% of total billed charges,103.5,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,101.89,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,36.8,32,,,percent of total billed charges,32% of total billed charges,92,80,,,percent of total billed charges,80% of total billed charges,92,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,104.65,91,,,percent of total billed charges,91% of total billed charges,37.54,32.64,,,percent of total billed charges,32.64% of total billed charges,36.8,32,,,percent of total billed charges,32% of total billed charges,38.64,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,36.8,32,,,percent of total billed charges,32% of total billed charges,36.8,32,,,percent of total billed charges,32% of total billed charges,105.8,92,,,percent of total billed charges,92% of total billed charges,13.55,105.8,
TESTOSTERONE FREE(includes Total),2000248,CDM,301,RC,84402,HCPCS,Outpatient,,,118,100.3,,95.82,81.2,,,percent of total billed charges,81.2% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,89.68,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,38.89,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,104.55,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,107.38,91,,,percent of total billed charges,91% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,39.65,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,108.56,92,,,percent of total billed charges,92% of total billed charges,13.55,108.56,
TESTOSTERONE TOTAL,2000195,CDM,301,RC,84403,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,13.55,93.84,
VITAMIN B1 Whole Blood,2000556,CDM,301,RC,84425,HCPCS,Outpatient,,,138,117.3,,112.06,81.2,,,percent of total billed charges,81.2% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,104.88,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,45.48,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,122.27,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,125.58,91,,,percent of total billed charges,91% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,46.37,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,126.96,92,,,percent of total billed charges,92% of total billed charges,11.18,126.96,
BECKMAN ASSAY COMPREHENSIVE THYROGLOBULI,2001758,CDM,300,RC,84432,HCPCS,Outpatient,,,83,70.55,,67.4,81.2,,,percent of total billed charges,81.2% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,63.08,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,27.36,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,74.7,90,,,percent of total billed charges,90% of total billed charges,74.7,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,73.54,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,75.53,91,,,percent of total billed charges,91% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,27.89,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,76.36,92,,,percent of total billed charges,92% of total billed charges,13.55,76.36,
THYROGLOBULIN,2000296,CDM,302,RC,84432,HCPCS,Outpatient,,,83,70.55,,67.4,81.2,,,percent of total billed charges,81.2% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,63.08,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,27.36,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,74.7,90,,,percent of total billed charges,90% of total billed charges,74.7,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,73.54,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,75.53,91,,,percent of total billed charges,91% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,27.89,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,76.36,92,,,percent of total billed charges,92% of total billed charges,13.55,76.36,
T4,2000137,CDM,301,RC,84436,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,13.55,93.84,
T4 FREE,2000252,CDM,301,RC,84439,HCPCS,Outpatient,,,90,76.5,,73.08,81.2,,,percent of total billed charges,81.2% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,68.4,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,29.66,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,79.74,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,81.9,91,,,percent of total billed charges,91% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,30.24,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,82.8,92,,,percent of total billed charges,92% of total billed charges,13.55,82.8,
T4 FREE DIALYSIS,2001071,CDM,301,RC,84439,HCPCS,Outpatient,,,90,76.5,,73.08,81.2,,,percent of total billed charges,81.2% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,68.4,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,29.66,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,79.74,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,81.9,91,,,percent of total billed charges,91% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,30.24,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,82.8,92,,,percent of total billed charges,92% of total billed charges,13.55,82.8,
THYROXINE BINDING GLOBULIN,2000732,CDM,300,RC,84442,HCPCS,Outpatient,,,80,68,,64.96,81.2,,,percent of total billed charges,81.2% of total billed charges,26.11,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,74,,,percent of total billed charges,74% of total billed charges,59.2,74,,,percent of total billed charges,74% of total billed charges,25.6,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,25.6,32,,,percent of total billed charges,32% of total billed charges,56.8,71,,,percent of total billed charges,71% of total billed charges,56.8,71,,,percent of total billed charges,71% of total billed charges,53.6,67,,,percent of total billed charges,67% of total billed charges,53.6,67,,,percent of total billed charges,67% of total billed charges,56.8,71,,,percent of total billed charges,71% of total billed charges,60.8,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.37,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,72,90,,,percent of total billed charges,90% of total billed charges,72,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,70.88,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,25.6,32,,,percent of total billed charges,32% of total billed charges,64,80,,,percent of total billed charges,80% of total billed charges,64,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,72.8,91,,,percent of total billed charges,91% of total billed charges,26.11,32.64,,,percent of total billed charges,32.64% of total billed charges,25.6,32,,,percent of total billed charges,32% of total billed charges,26.88,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,25.6,32,,,percent of total billed charges,32% of total billed charges,25.6,32,,,percent of total billed charges,32% of total billed charges,73.6,92,,,percent of total billed charges,92% of total billed charges,13.55,73.6,
TSH 3RD GENERATION,2001177,CDM,301,RC,84443,HCPCS,Outpatient,,,124,105.4,,100.69,81.2,,,percent of total billed charges,81.2% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,94.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,40.87,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,109.86,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,112.84,91,,,percent of total billed charges,91% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,41.66,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,114.08,92,,,percent of total billed charges,92% of total billed charges,13.55,114.08,
TSH THYROID STIM HORMONE,2000139,CDM,301,RC,84443,HCPCS,Outpatient,,,124,105.4,,100.69,81.2,,,percent of total billed charges,81.2% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,91.76,74,,,percent of total billed charges,74% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,83.08,67,,,percent of total billed charges,67% of total billed charges,88.04,71,,,percent of total billed charges,71% of total billed charges,94.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,40.87,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,109.86,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,99.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,112.84,91,,,percent of total billed charges,91% of total billed charges,40.47,32.64,,,percent of total billed charges,32.64% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,41.66,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,39.68,32,,,percent of total billed charges,32% of total billed charges,39.68,32,,,percent of total billed charges,32% of total billed charges,114.08,92,,,percent of total billed charges,92% of total billed charges,13.55,114.08,
THYROID STIMULATING IMMUNOGLO,2000686,CDM,301,RC,84445,HCPCS,Outpatient,,,185,157.25,,150.22,81.2,,,percent of total billed charges,81.2% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,140.6,76,,,percent of total billed charges,76% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,60.98,32.96,,,percent of total billed charges,32.96% of total billed charges,17.91,105,,,Fee Schedule,pays based on EAPG rates,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,163.91,88.6,,,percent of total billed charges,88.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,168.35,91,,,percent of total billed charges,91% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,62.16,33.6,,,percent of total billed charges,33.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,170.2,92,,,percent of total billed charges,92% of total billed charges,17.05,170.2,
VITAMIN E,2000897,CDM,300,RC,84446,HCPCS,Outpatient,,,219,186.15,,177.83,81.2,,,percent of total billed charges,81.2% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,166.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,72.18,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,197.1,90,,,percent of total billed charges,90% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,194.03,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,199.29,91,,,percent of total billed charges,91% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,73.58,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,201.48,92,,,percent of total billed charges,92% of total billed charges,11.18,201.48,
SGOT AST,2000128,CDM,301,RC,84450,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,7.24,69,
SGPT ALTI,2000129,CDM,301,RC,84460,HCPCS,Outpatient,,,71,60.35,,57.65,81.2,,,percent of total billed charges,81.2% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,53.96,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,23.4,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,63.9,90,,,percent of total billed charges,90% of total billed charges,63.9,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,62.91,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,64.61,91,,,percent of total billed charges,91% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,23.86,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,65.32,92,,,percent of total billed charges,92% of total billed charges,7.24,65.32,
TRANSFERRIN,2000194,CDM,301,RC,84466,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,11.18,70.84,
TRIGLYCERIDES,2000142,CDM,301,RC,84478,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
T3 UPTAKE,2000136,CDM,301,RC,84479,HCPCS,Outpatient,,,94,79.9,,76.33,81.2,,,percent of total billed charges,81.2% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,71.44,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,30.98,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,84.6,90,,,percent of total billed charges,90% of total billed charges,84.6,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,83.28,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,85.54,91,,,percent of total billed charges,91% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,31.58,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,86.48,92,,,percent of total billed charges,92% of total billed charges,13.55,86.48,
T3 TOTAL,2000789,CDM,301,RC,84480,HCPCS,Outpatient,,,82,69.7,,66.58,81.2,,,percent of total billed charges,81.2% of total billed charges,26.76,32.64,,,percent of total billed charges,32.64% of total billed charges,60.68,74,,,percent of total billed charges,74% of total billed charges,60.68,74,,,percent of total billed charges,74% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,54.94,67,,,percent of total billed charges,67% of total billed charges,54.94,67,,,percent of total billed charges,67% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,62.32,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,27.03,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,73.8,90,,,percent of total billed charges,90% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,72.65,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,65.6,80,,,percent of total billed charges,80% of total billed charges,65.6,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,74.62,91,,,percent of total billed charges,91% of total billed charges,26.76,32.64,,,percent of total billed charges,32.64% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,27.55,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,75.44,92,,,percent of total billed charges,92% of total billed charges,13.55,75.44,
T3 FREE TRIODOTHYRONINE,2000445,CDM,301,RC,84481,HCPCS,Outpatient,,,149,126.65,,120.99,81.2,,,percent of total billed charges,81.2% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,113.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,49.11,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,132.01,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,135.59,91,,,percent of total billed charges,91% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,50.06,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,137.08,92,,,percent of total billed charges,92% of total billed charges,13.55,137.08,
T3 REVERSE,2000567,CDM,301,RC,84482,HCPCS,Outpatient,,,64,54.4,,51.97,81.2,,,percent of total billed charges,81.2% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,48.64,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,21.09,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,57.6,90,,,percent of total billed charges,90% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,56.7,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,58.24,91,,,percent of total billed charges,91% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,21.5,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,58.88,92,,,percent of total billed charges,92% of total billed charges,13.55,58.88,
HS TROPONIN,2001843,CDM,301,RC,84484,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,11.18,112.24,
BUN,2000019,CDM,301,RC,84520,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,7.24,69,
URIC ACID,2000143,CDM,301,RC,84550,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,7.24,70.84,
URIC ACID URINE 24 HOUR,2000299,CDM,301,RC,84560,HCPCS,Outpatient,,,46,39.1,,37.35,81.2,,,percent of total billed charges,81.2% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,34.96,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,15.16,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,41.4,90,,,percent of total billed charges,90% of total billed charges,41.4,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,40.76,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,41.86,91,,,percent of total billed charges,91% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,15.46,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,42.32,92,,,percent of total billed charges,92% of total billed charges,7.24,42.32,
VANILLYLMANDELIC ACID 24 HOUR URINE,2001109,CDM,301,RC,84585,HCPCS,Outpatient,,,111,94.35,,90.13,81.2,,,percent of total billed charges,81.2% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,84.36,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,36.59,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,98.35,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,101.01,91,,,percent of total billed charges,91% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,37.3,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,102.12,92,,,percent of total billed charges,92% of total billed charges,13.55,102.12,
VMA URINE RANDOM,2000147,CDM,301,RC,84585,HCPCS,Outpatient,,,111,94.35,,90.13,81.2,,,percent of total billed charges,81.2% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,82.14,74,,,percent of total billed charges,74% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,74.37,67,,,percent of total billed charges,67% of total billed charges,78.81,71,,,percent of total billed charges,71% of total billed charges,84.36,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,36.59,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,98.35,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,88.8,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,101.01,91,,,percent of total billed charges,91% of total billed charges,36.23,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,37.3,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.52,32,,,percent of total billed charges,32% of total billed charges,35.52,32,,,percent of total billed charges,32% of total billed charges,102.12,92,,,percent of total billed charges,92% of total billed charges,13.55,102.12,
VASOPRESSIN LEVEL ADH,2000636,CDM,301,RC,84588,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,17.91,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,17.05,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,17.57,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,15.36,44.16,
VITAMIN A RETINOL,2000304,CDM,301,RC,84590,HCPCS,Outpatient,,,44,37.4,,35.73,81.2,,,percent of total billed charges,81.2% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,33.44,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,14.5,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,39.6,90,,,percent of total billed charges,90% of total billed charges,39.6,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,38.98,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,40.04,91,,,percent of total billed charges,91% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,14.78,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,40.48,92,,,percent of total billed charges,92% of total billed charges,11.18,40.48,
VITAMIN B5,2001718,CDM,301,RC,84591,HCPCS,Outpatient,,,107,90.95,,86.88,81.2,,,percent of total billed charges,81.2% of total billed charges,34.92,32.64,,,percent of total billed charges,32.64% of total billed charges,79.18,74,,,percent of total billed charges,74% of total billed charges,79.18,74,,,percent of total billed charges,74% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,71.69,67,,,percent of total billed charges,67% of total billed charges,71.69,67,,,percent of total billed charges,67% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,81.32,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.27,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,96.3,90,,,percent of total billed charges,90% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,94.8,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,97.37,91,,,percent of total billed charges,91% of total billed charges,34.92,32.64,,,percent of total billed charges,32.64% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,35.95,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,98.44,92,,,percent of total billed charges,92% of total billed charges,11.18,98.44,
VITAMIN B7,2001459,CDM,301,RC,84591,HCPCS,Outpatient,,,107,90.95,,86.88,81.2,,,percent of total billed charges,81.2% of total billed charges,34.92,32.64,,,percent of total billed charges,32.64% of total billed charges,79.18,74,,,percent of total billed charges,74% of total billed charges,79.18,74,,,percent of total billed charges,74% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,71.69,67,,,percent of total billed charges,67% of total billed charges,71.69,67,,,percent of total billed charges,67% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,81.32,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,35.27,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,96.3,90,,,percent of total billed charges,90% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,94.8,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,97.37,91,,,percent of total billed charges,91% of total billed charges,34.92,32.64,,,percent of total billed charges,32.64% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,35.95,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,98.44,92,,,percent of total billed charges,92% of total billed charges,11.18,98.44,
VITAMIN K,2001001,CDM,300,RC,84597,HCPCS,Outpatient,,,181,153.85,,146.97,81.2,,,percent of total billed charges,81.2% of total billed charges,59.08,32.64,,,percent of total billed charges,32.64% of total billed charges,133.94,74,,,percent of total billed charges,74% of total billed charges,133.94,74,,,percent of total billed charges,74% of total billed charges,57.92,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,57.92,32,,,percent of total billed charges,32% of total billed charges,128.51,71,,,percent of total billed charges,71% of total billed charges,128.51,71,,,percent of total billed charges,71% of total billed charges,121.27,67,,,percent of total billed charges,67% of total billed charges,121.27,67,,,percent of total billed charges,67% of total billed charges,128.51,71,,,percent of total billed charges,71% of total billed charges,137.56,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,59.66,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,160.37,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,57.92,32,,,percent of total billed charges,32% of total billed charges,144.8,80,,,percent of total billed charges,80% of total billed charges,144.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,164.71,91,,,percent of total billed charges,91% of total billed charges,59.08,32.64,,,percent of total billed charges,32.64% of total billed charges,57.92,32,,,percent of total billed charges,32% of total billed charges,60.82,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,57.92,32,,,percent of total billed charges,32% of total billed charges,57.92,32,,,percent of total billed charges,32% of total billed charges,166.52,92,,,percent of total billed charges,92% of total billed charges,11.18,166.52,
METHANOL,2000664,CDM,301,RC,84600,HCPCS,Outpatient,,,64,54.4,,51.97,81.2,,,percent of total billed charges,81.2% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,48.64,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.09,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,57.6,90,,,percent of total billed charges,90% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,56.7,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,58.24,91,,,percent of total billed charges,91% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,21.5,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,58.88,92,,,percent of total billed charges,92% of total billed charges,11.18,58.88,
VOLATILES BLOOD or URINE,2000288,CDM,301,RC,84600,HCPCS,Outpatient,,,64,54.4,,51.97,81.2,,,percent of total billed charges,81.2% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,48.64,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.09,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,57.6,90,,,percent of total billed charges,90% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,56.7,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,58.24,91,,,percent of total billed charges,91% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,21.5,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,58.88,92,,,percent of total billed charges,92% of total billed charges,11.18,58.88,
ZINC,2000353,CDM,301,RC,84630,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,10.48,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,9.98,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,10.28,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,9.98,46,
C PEPTIDE,2000403,CDM,301,RC,84681,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,11.18,64.4,
BETA HCG QUANT,2000016,CDM,301,RC,84702,HCPCS,Outpatient,,,130,110.5,,105.56,81.2,,,percent of total billed charges,81.2% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,98.8,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,42.85,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,117,90,,,percent of total billed charges,90% of total billed charges,117,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,115.18,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,118.3,91,,,percent of total billed charges,91% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,43.68,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,119.6,92,,,percent of total billed charges,92% of total billed charges,13.55,119.6,
BETA HCG TUMOR MARKER,2000411,CDM,301,RC,84702,HCPCS,Outpatient,,,130,110.5,,105.56,81.2,,,percent of total billed charges,81.2% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,96.2,74,,,percent of total billed charges,74% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,87.1,67,,,percent of total billed charges,67% of total billed charges,92.3,71,,,percent of total billed charges,71% of total billed charges,98.8,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,42.85,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,117,90,,,percent of total billed charges,90% of total billed charges,117,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,115.18,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,104,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,118.3,91,,,percent of total billed charges,91% of total billed charges,42.43,32.64,,,percent of total billed charges,32.64% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,43.68,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,41.6,32,,,percent of total billed charges,32% of total billed charges,41.6,32,,,percent of total billed charges,32% of total billed charges,119.6,92,,,percent of total billed charges,92% of total billed charges,13.55,119.6,
"BHCG SERUM, QUALITATIVE PREGNANCY",2000443,CDM,301,RC,84703,HCPCS,Outpatient,,,113,96.05,,91.76,81.2,,,percent of total billed charges,81.2% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,85.88,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,37.24,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,100.12,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,102.83,91,,,percent of total billed charges,91% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,37.97,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,103.96,92,,,percent of total billed charges,92% of total billed charges,7.24,103.96,
WBC DIFFERENTIAL,2000540,CDM,305,RC,85007,HCPCS,Outpatient,,,64,54.4,,51.97,81.2,,,percent of total billed charges,81.2% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,48.64,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,21.09,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,57.6,90,,,percent of total billed charges,90% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,56.7,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,58.24,91,,,percent of total billed charges,91% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,21.5,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,58.88,92,,,percent of total billed charges,92% of total billed charges,5.23,58.88,
HEMATOCRIT,2000073,CDM,305,RC,85014,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,5.23,41.4,
HEMOGLOBIN,2000072,CDM,305,RC,85018,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,5.23,41.4,
CBC WITH DIFF,2099003,CDM,300,RC,85025,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,5.23,85.56,
CBC/DIFF and PLATELET,2000024,CDM,305,RC,85025,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,5.23,85.56,
"CBC, W/O DIFF",2099037,CDM,305,RC,85027,HCPCS,Outpatient,,,44,37.4,,35.73,81.2,,,percent of total billed charges,81.2% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,33.44,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.5,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,39.6,90,,,percent of total billed charges,90% of total billed charges,39.6,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,38.98,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,40.04,91,,,percent of total billed charges,91% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,14.78,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,40.48,92,,,percent of total billed charges,92% of total billed charges,5.23,40.48,
RETICULOYCTE COUNT,2000122,CDM,305,RC,85045,HCPCS,Outpatient,,,46,39.1,,37.35,81.2,,,percent of total billed charges,81.2% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,34.96,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,15.16,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,41.4,90,,,percent of total billed charges,90% of total billed charges,41.4,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,40.76,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,41.86,91,,,percent of total billed charges,91% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,15.46,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,42.32,92,,,percent of total billed charges,92% of total billed charges,5.23,42.32,
EOSINOPHIL COUNT,2000054,CDM,305,RC,85048,HCPCS,Outpatient,,,30,25.5,,24.36,81.2,,,percent of total billed charges,81.2% of total billed charges,9.79,32.64,,,percent of total billed charges,32.64% of total billed charges,22.2,74,,,percent of total billed charges,74% of total billed charges,22.2,74,,,percent of total billed charges,74% of total billed charges,9.6,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,9.6,32,,,percent of total billed charges,32% of total billed charges,21.3,71,,,percent of total billed charges,71% of total billed charges,21.3,71,,,percent of total billed charges,71% of total billed charges,20.1,67,,,percent of total billed charges,67% of total billed charges,20.1,67,,,percent of total billed charges,67% of total billed charges,21.3,71,,,percent of total billed charges,71% of total billed charges,22.8,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,9.89,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,27,90,,,percent of total billed charges,90% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,26.58,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,9.6,32,,,percent of total billed charges,32% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,27.3,91,,,percent of total billed charges,91% of total billed charges,9.79,32.64,,,percent of total billed charges,32.64% of total billed charges,9.6,32,,,percent of total billed charges,32% of total billed charges,10.08,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,9.6,32,,,percent of total billed charges,32% of total billed charges,9.6,32,,,percent of total billed charges,32% of total billed charges,27.6,92,,,percent of total billed charges,92% of total billed charges,5.23,27.6,
WHITE BLOOD COUNT,2000149,CDM,305,RC,85048,HCPCS,Outpatient,,,30,25.5,,24.36,81.2,,,percent of total billed charges,81.2% of total billed charges,9.79,32.64,,,percent of total billed charges,32.64% of total billed charges,22.2,74,,,percent of total billed charges,74% of total billed charges,22.2,74,,,percent of total billed charges,74% of total billed charges,9.6,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,9.6,32,,,percent of total billed charges,32% of total billed charges,21.3,71,,,percent of total billed charges,71% of total billed charges,21.3,71,,,percent of total billed charges,71% of total billed charges,20.1,67,,,percent of total billed charges,67% of total billed charges,20.1,67,,,percent of total billed charges,67% of total billed charges,21.3,71,,,percent of total billed charges,71% of total billed charges,22.8,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,9.89,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,27,90,,,percent of total billed charges,90% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,26.58,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,9.6,32,,,percent of total billed charges,32% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,24,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,27.3,91,,,percent of total billed charges,91% of total billed charges,9.79,32.64,,,percent of total billed charges,32.64% of total billed charges,9.6,32,,,percent of total billed charges,32% of total billed charges,10.08,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,9.6,32,,,percent of total billed charges,32% of total billed charges,9.6,32,,,percent of total billed charges,32% of total billed charges,27.6,92,,,percent of total billed charges,92% of total billed charges,5.23,27.6,
PLATELET COUNT AUTOMATED,2000435,CDM,305,RC,85049,HCPCS,Outpatient,,,49,41.65,,39.79,81.2,,,percent of total billed charges,81.2% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,37.24,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,16.15,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,44.1,90,,,percent of total billed charges,90% of total billed charges,44.1,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,43.41,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,44.59,91,,,percent of total billed charges,91% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,16.46,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,45.08,92,,,percent of total billed charges,92% of total billed charges,5.23,45.08,
BONE MARROW,2000179,CDM,300,RC,85097,HCPCS,Outpatient,,,108,91.8,,87.7,81.2,,,percent of total billed charges,81.2% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,82.08,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,35.6,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,95.69,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,98.28,91,,,percent of total billed charges,91% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,36.29,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,99.36,92,,,percent of total billed charges,92% of total billed charges,28.01,99.36,
BONE MARROW PERIPHERAL SMEAR,2000377,CDM,305,RC,85097,HCPCS,Outpatient,,,108,91.8,,87.7,81.2,,,percent of total billed charges,81.2% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,82.08,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,35.6,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,95.69,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,98.28,91,,,percent of total billed charges,91% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,36.29,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,99.36,92,,,percent of total billed charges,92% of total billed charges,28.01,99.36,
BONE MARROW SMEAR INTERP,2000579,CDM,305,RC,85097,HCPCS,Outpatient,,,108,91.8,,87.7,81.2,,,percent of total billed charges,81.2% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,82.08,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,35.6,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,95.69,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,98.28,91,,,percent of total billed charges,91% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,36.29,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,99.36,92,,,percent of total billed charges,92% of total billed charges,28.01,99.36,
FACTOR II ACTIVITY,2001005,CDM,300,RC,85210,HCPCS,Outpatient,,,78,66.3,,63.34,81.2,,,percent of total billed charges,81.2% of total billed charges,25.46,32.64,,,percent of total billed charges,32.64% of total billed charges,57.72,74,,,percent of total billed charges,74% of total billed charges,57.72,74,,,percent of total billed charges,74% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,52.26,67,,,percent of total billed charges,67% of total billed charges,52.26,67,,,percent of total billed charges,67% of total billed charges,55.38,71,,,percent of total billed charges,71% of total billed charges,59.28,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,25.71,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,70.2,90,,,percent of total billed charges,90% of total billed charges,70.2,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,69.11,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,62.4,80,,,percent of total billed charges,80% of total billed charges,62.4,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,70.98,91,,,percent of total billed charges,91% of total billed charges,25.46,32.64,,,percent of total billed charges,32.64% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,26.21,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,24.96,32,,,percent of total billed charges,32% of total billed charges,24.96,32,,,percent of total billed charges,32% of total billed charges,71.76,92,,,percent of total billed charges,92% of total billed charges,5.98,71.76,
FACTOR V ACTIVITY,2000469,CDM,305,RC,85220,HCPCS,Outpatient,,,169,143.65,,137.23,81.2,,,percent of total billed charges,81.2% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,128.44,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,55.7,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,152.1,90,,,percent of total billed charges,90% of total billed charges,152.1,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,149.73,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,153.79,91,,,percent of total billed charges,91% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,56.78,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,155.48,92,,,percent of total billed charges,92% of total billed charges,28.96,155.48,
FACTOR VII ACTIVITY,2000470,CDM,305,RC,85230,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,28.96,112.24,
FACTOR VIII ACTIVITY,2000315,CDM,305,RC,85240,HCPCS,Outpatient,,,161,136.85,,130.73,81.2,,,percent of total billed charges,81.2% of total billed charges,52.55,32.64,,,percent of total billed charges,32.64% of total billed charges,119.14,74,,,percent of total billed charges,74% of total billed charges,119.14,74,,,percent of total billed charges,74% of total billed charges,51.52,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,51.52,32,,,percent of total billed charges,32% of total billed charges,114.31,71,,,percent of total billed charges,71% of total billed charges,114.31,71,,,percent of total billed charges,71% of total billed charges,107.87,67,,,percent of total billed charges,67% of total billed charges,107.87,67,,,percent of total billed charges,67% of total billed charges,114.31,71,,,percent of total billed charges,71% of total billed charges,122.36,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,53.07,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,144.9,90,,,percent of total billed charges,90% of total billed charges,144.9,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,142.65,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,51.52,32,,,percent of total billed charges,32% of total billed charges,128.8,80,,,percent of total billed charges,80% of total billed charges,128.8,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,146.51,91,,,percent of total billed charges,91% of total billed charges,52.55,32.64,,,percent of total billed charges,32.64% of total billed charges,51.52,32,,,percent of total billed charges,32% of total billed charges,54.1,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,51.52,32,,,percent of total billed charges,32% of total billed charges,51.52,32,,,percent of total billed charges,32% of total billed charges,148.12,92,,,percent of total billed charges,92% of total billed charges,28.96,148.12,
FACTOR-VON WILLEBRAND PROFILE,2000605,CDM,305,RC,85245,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,28.96,197.8,
VWF ACTIVITY,2001198,CDM,305,RC,85245,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,28.96,197.8,
FACTOR VIII vWF ANTIGEN,2000548,CDM,305,RC,85246,HCPCS,Outpatient,,,206,175.1,,167.27,81.2,,,percent of total billed charges,81.2% of total billed charges,67.24,32.64,,,percent of total billed charges,32.64% of total billed charges,152.44,74,,,percent of total billed charges,74% of total billed charges,152.44,74,,,percent of total billed charges,74% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,138.02,67,,,percent of total billed charges,67% of total billed charges,138.02,67,,,percent of total billed charges,67% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,156.56,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,67.9,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,185.4,90,,,percent of total billed charges,90% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,182.52,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,187.46,91,,,percent of total billed charges,91% of total billed charges,67.24,32.64,,,percent of total billed charges,32.64% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,69.22,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,189.52,92,,,percent of total billed charges,92% of total billed charges,28.96,189.52,
FACTOR VIII vWF MULTIMETRIC ANALYS,2000606,CDM,305,RC,85247,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,15.36,44.16,
FACTOR IX activity,2000544,CDM,305,RC,85250,HCPCS,Outpatient,,,146,124.1,,118.55,81.2,,,percent of total billed charges,81.2% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,108.04,74,,,percent of total billed charges,74% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,97.82,67,,,percent of total billed charges,67% of total billed charges,103.66,71,,,percent of total billed charges,71% of total billed charges,110.96,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,48.12,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,129.36,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,116.8,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,132.86,91,,,percent of total billed charges,91% of total billed charges,47.65,32.64,,,percent of total billed charges,32.64% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,49.06,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,46.72,32,,,percent of total billed charges,32% of total billed charges,46.72,32,,,percent of total billed charges,32% of total billed charges,134.32,92,,,percent of total billed charges,92% of total billed charges,28.96,134.32,
FACTOR XII ACTIVITY,2000722,CDM,300,RC,85280,HCPCS,Outpatient,,,247,209.95,,200.56,81.2,,,percent of total billed charges,81.2% of total billed charges,80.62,32.64,,,percent of total billed charges,32.64% of total billed charges,182.78,74,,,percent of total billed charges,74% of total billed charges,182.78,74,,,percent of total billed charges,74% of total billed charges,79.04,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,79.04,32,,,percent of total billed charges,32% of total billed charges,175.37,71,,,percent of total billed charges,71% of total billed charges,175.37,71,,,percent of total billed charges,71% of total billed charges,165.49,67,,,percent of total billed charges,67% of total billed charges,165.49,67,,,percent of total billed charges,67% of total billed charges,175.37,71,,,percent of total billed charges,71% of total billed charges,187.72,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,81.41,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,222.3,90,,,percent of total billed charges,90% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,218.84,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,79.04,32,,,percent of total billed charges,32% of total billed charges,197.6,80,,,percent of total billed charges,80% of total billed charges,197.6,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,224.77,91,,,percent of total billed charges,91% of total billed charges,80.62,32.64,,,percent of total billed charges,32.64% of total billed charges,79.04,32,,,percent of total billed charges,32% of total billed charges,82.99,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,79.04,32,,,percent of total billed charges,32% of total billed charges,79.04,32,,,percent of total billed charges,32% of total billed charges,227.24,92,,,percent of total billed charges,92% of total billed charges,28.96,227.24,
ANTITHROMBIN ACTIVITY,2000937,CDM,300,RC,85300,HCPCS,Outpatient,,,323,274.55,,262.28,81.2,,,percent of total billed charges,81.2% of total billed charges,105.43,32.64,,,percent of total billed charges,32.64% of total billed charges,239.02,74,,,percent of total billed charges,74% of total billed charges,239.02,74,,,percent of total billed charges,74% of total billed charges,103.36,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,103.36,32,,,percent of total billed charges,32% of total billed charges,229.33,71,,,percent of total billed charges,71% of total billed charges,229.33,71,,,percent of total billed charges,71% of total billed charges,216.41,67,,,percent of total billed charges,67% of total billed charges,216.41,67,,,percent of total billed charges,67% of total billed charges,229.33,71,,,percent of total billed charges,71% of total billed charges,245.48,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,106.46,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,290.7,90,,,percent of total billed charges,90% of total billed charges,290.7,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,286.18,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,103.36,32,,,percent of total billed charges,32% of total billed charges,258.4,80,,,percent of total billed charges,80% of total billed charges,258.4,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,293.93,91,,,percent of total billed charges,91% of total billed charges,105.43,32.64,,,percent of total billed charges,32.64% of total billed charges,103.36,32,,,percent of total billed charges,32% of total billed charges,108.53,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,103.36,32,,,percent of total billed charges,32% of total billed charges,103.36,32,,,percent of total billed charges,32% of total billed charges,297.16,92,,,percent of total billed charges,92% of total billed charges,5.98,297.16,
ANTITHROMBIN ANTIGEN,2000936,CDM,300,RC,85301,HCPCS,Outpatient,,,325,276.25,,263.9,81.2,,,percent of total billed charges,81.2% of total billed charges,106.08,32.64,,,percent of total billed charges,32.64% of total billed charges,240.5,74,,,percent of total billed charges,74% of total billed charges,240.5,74,,,percent of total billed charges,74% of total billed charges,104,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,104,32,,,percent of total billed charges,32% of total billed charges,230.75,71,,,percent of total billed charges,71% of total billed charges,230.75,71,,,percent of total billed charges,71% of total billed charges,217.75,67,,,percent of total billed charges,67% of total billed charges,217.75,67,,,percent of total billed charges,67% of total billed charges,230.75,71,,,percent of total billed charges,71% of total billed charges,247,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,107.12,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,292.5,90,,,percent of total billed charges,90% of total billed charges,292.5,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,287.95,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,104,32,,,percent of total billed charges,32% of total billed charges,260,80,,,percent of total billed charges,80% of total billed charges,260,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,295.75,91,,,percent of total billed charges,91% of total billed charges,106.08,32.64,,,percent of total billed charges,32.64% of total billed charges,104,32,,,percent of total billed charges,32% of total billed charges,109.2,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,104,32,,,percent of total billed charges,32% of total billed charges,104,32,,,percent of total billed charges,32% of total billed charges,299,92,,,percent of total billed charges,92% of total billed charges,5.98,299,
PROTEIN C ANTIGEN,2000275,CDM,305,RC,85302,HCPCS,Outpatient,,,347,294.95,,281.76,81.2,,,percent of total billed charges,81.2% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,263.72,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,114.37,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,312.3,90,,,percent of total billed charges,90% of total billed charges,312.3,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,307.44,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,315.77,91,,,percent of total billed charges,91% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,116.59,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,319.24,92,,,percent of total billed charges,92% of total billed charges,5.98,319.24,
PROTEIN C FUNCTIONAL ACTIVITY,2000417,CDM,305,RC,85303,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,5.98,91.08,
PROTEIN S ANTIGEN/TOTAL/FREE,2000276,CDM,305,RC,85305,HCPCS,Outpatient,,,289,245.65,,234.67,81.2,,,percent of total billed charges,81.2% of total billed charges,94.33,32.64,,,percent of total billed charges,32.64% of total billed charges,213.86,74,,,percent of total billed charges,74% of total billed charges,213.86,74,,,percent of total billed charges,74% of total billed charges,92.48,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,92.48,32,,,percent of total billed charges,32% of total billed charges,205.19,71,,,percent of total billed charges,71% of total billed charges,205.19,71,,,percent of total billed charges,71% of total billed charges,193.63,67,,,percent of total billed charges,67% of total billed charges,193.63,67,,,percent of total billed charges,67% of total billed charges,205.19,71,,,percent of total billed charges,71% of total billed charges,219.64,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,95.25,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,260.1,90,,,percent of total billed charges,90% of total billed charges,260.1,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,256.05,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,92.48,32,,,percent of total billed charges,32% of total billed charges,231.2,80,,,percent of total billed charges,80% of total billed charges,231.2,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,262.99,91,,,percent of total billed charges,91% of total billed charges,94.33,32.64,,,percent of total billed charges,32.64% of total billed charges,92.48,32,,,percent of total billed charges,32% of total billed charges,97.1,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,92.48,32,,,percent of total billed charges,32% of total billed charges,92.48,32,,,percent of total billed charges,32% of total billed charges,265.88,92,,,percent of total billed charges,92% of total billed charges,5.98,265.88,
PROTEIN S FREE,2001635,CDM,305,RC,85306,HCPCS,Outpatient,,,92,78.2,,74.7,81.2,,,percent of total billed charges,81.2% of total billed charges,30.03,32.64,,,percent of total billed charges,32.64% of total billed charges,68.08,74,,,percent of total billed charges,74% of total billed charges,68.08,74,,,percent of total billed charges,74% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,61.64,67,,,percent of total billed charges,67% of total billed charges,61.64,67,,,percent of total billed charges,67% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,69.92,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,30.32,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,82.8,90,,,percent of total billed charges,90% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,81.51,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,73.6,80,,,percent of total billed charges,80% of total billed charges,73.6,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,83.72,91,,,percent of total billed charges,91% of total billed charges,30.03,32.64,,,percent of total billed charges,32.64% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,30.91,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,84.64,92,,,percent of total billed charges,92% of total billed charges,5.98,84.64,
PROTEIN S FUNCTIONAL,2000418,CDM,305,RC,85306,HCPCS,Outpatient,,,92,78.2,,74.7,81.2,,,percent of total billed charges,81.2% of total billed charges,30.03,32.64,,,percent of total billed charges,32.64% of total billed charges,68.08,74,,,percent of total billed charges,74% of total billed charges,68.08,74,,,percent of total billed charges,74% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,61.64,67,,,percent of total billed charges,67% of total billed charges,61.64,67,,,percent of total billed charges,67% of total billed charges,65.32,71,,,percent of total billed charges,71% of total billed charges,69.92,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,30.32,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,82.8,90,,,percent of total billed charges,90% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,81.51,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,73.6,80,,,percent of total billed charges,80% of total billed charges,73.6,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,83.72,91,,,percent of total billed charges,91% of total billed charges,30.03,32.64,,,percent of total billed charges,32.64% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,30.91,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,29.44,32,,,percent of total billed charges,32% of total billed charges,29.44,32,,,percent of total billed charges,32% of total billed charges,84.64,92,,,percent of total billed charges,92% of total billed charges,5.98,84.64,
PROTEIN C ACTIVATED RESISTANCE,2000637,CDM,305,RC,85307,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,11.18,79.12,
FACTOR INHIBITOR,2000487,CDM,305,RC,85335,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,5.98,74.52,
FACTOR 8 INHIBITOR,2001418,CDM,305,RC,85335,HCPCS,Outpatient,,,539,458.15,,437.67,81.2,,,percent of total billed charges,81.2% of total billed charges,175.93,32.64,,,percent of total billed charges,32.64% of total billed charges,398.86,74,,,percent of total billed charges,74% of total billed charges,398.86,74,,,percent of total billed charges,74% of total billed charges,172.48,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,172.48,32,,,percent of total billed charges,32% of total billed charges,382.69,71,,,percent of total billed charges,71% of total billed charges,382.69,71,,,percent of total billed charges,71% of total billed charges,361.13,67,,,percent of total billed charges,67% of total billed charges,361.13,67,,,percent of total billed charges,67% of total billed charges,382.69,71,,,percent of total billed charges,71% of total billed charges,409.64,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,177.65,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,485.1,90,,,percent of total billed charges,90% of total billed charges,485.1,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,477.55,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,172.48,32,,,percent of total billed charges,32% of total billed charges,431.2,80,,,percent of total billed charges,80% of total billed charges,431.2,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,490.49,91,,,percent of total billed charges,91% of total billed charges,175.93,32.64,,,percent of total billed charges,32.64% of total billed charges,172.48,32,,,percent of total billed charges,32% of total billed charges,181.1,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,172.48,32,,,percent of total billed charges,32% of total billed charges,172.48,32,,,percent of total billed charges,32% of total billed charges,495.88,92,,,percent of total billed charges,92% of total billed charges,5.98,495.88,
D DIMER QUANTITATIVE,2000313,CDM,305,RC,85379,HCPCS,Outpatient,,,90,76.5,,73.08,81.2,,,percent of total billed charges,81.2% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,68.4,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,29.66,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,79.74,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,81.9,91,,,percent of total billed charges,91% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,30.24,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,82.8,92,,,percent of total billed charges,92% of total billed charges,5.98,82.8,
FIBRINOGEN,2000060,CDM,305,RC,85384,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,5.98,93.84,
PLASMINOGEN ACTIVATOR INHIBITO,2000806,CDM,300,RC,85415,HCPCS,Outpatient,,,305,259.25,,247.66,81.2,,,percent of total billed charges,81.2% of total billed charges,99.55,32.64,,,percent of total billed charges,32.64% of total billed charges,225.7,74,,,percent of total billed charges,74% of total billed charges,225.7,74,,,percent of total billed charges,74% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,204.35,67,,,percent of total billed charges,67% of total billed charges,204.35,67,,,percent of total billed charges,67% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,231.8,76,,,percent of total billed charges,76% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,100.53,32.96,,,percent of total billed charges,32.96% of total billed charges,30.41,105,,,Fee Schedule,pays based on EAPG rates,274.5,90,,,percent of total billed charges,90% of total billed charges,274.5,90,,,percent of total billed charges,90% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,270.23,88.6,,,percent of total billed charges,88.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,28.96,100,,,Fee Schedule,pays based on EAPG rates,277.55,91,,,percent of total billed charges,91% of total billed charges,99.55,32.64,,,percent of total billed charges,32.64% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,102.48,33.6,,,percent of total billed charges,33.6% of total billed charges,29.83,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,280.6,92,,,percent of total billed charges,92% of total billed charges,28.96,280.6,
BB KLEIHAUER BETKE,2000401,CDM,305,RC,85460,HCPCS,Outpatient,,,102,86.7,,82.82,81.2,,,percent of total billed charges,81.2% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,75.48,74,,,percent of total billed charges,74% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,1.9,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,68.34,67,,,percent of total billed charges,67% of total billed charges,72.42,71,,,percent of total billed charges,71% of total billed charges,77.52,76,,,percent of total billed charges,76% of total billed charges,1.9,103,,,Fee Schedule,pays based on EAPG rates,33.62,32.96,,,percent of total billed charges,32.96% of total billed charges,1.93,105,,,Fee Schedule,pays based on EAPG rates,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,1.84,100,,,Fee Schedule,pays based on EAPG rates,90.37,88.6,,,percent of total billed charges,88.6% of total billed charges,1.9,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,81.6,80,,,percent of total billed charges,80% of total billed charges,1.84,100,,,Fee Schedule,pays based on EAPG rates,92.82,91,,,percent of total billed charges,91% of total billed charges,33.29,32.64,,,percent of total billed charges,32.64% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,34.27,33.6,,,percent of total billed charges,33.6% of total billed charges,1.9,103,,,Fee Schedule,pays based on EAPG rates,32.64,32,,,percent of total billed charges,32% of total billed charges,32.64,32,,,percent of total billed charges,32% of total billed charges,93.84,92,,,percent of total billed charges,92% of total billed charges,1.84,93.84,
BB FETAL SCREEN MATERNAL,2000400,CDM,300,RC,85461,HCPCS,Outpatient,,,83,70.55,,67.4,81.2,,,percent of total billed charges,81.2% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,63.08,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,27.36,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,74.7,90,,,percent of total billed charges,90% of total billed charges,74.7,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,73.54,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,75.53,91,,,percent of total billed charges,91% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,27.89,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,76.36,92,,,percent of total billed charges,92% of total billed charges,5.23,76.36,
A-XaLMW  HEPARIN ASSAY,2001835,CDM,300,RC,85520,HCPCS,Outpatient,,,118,100.3,,95.82,81.2,,,percent of total billed charges,81.2% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,89.68,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,38.89,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,104.55,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,107.38,91,,,percent of total billed charges,91% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,39.65,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,108.56,92,,,percent of total billed charges,92% of total billed charges,5.98,108.56,
A-XaUFH HEPARIN ASSAY,2001834,CDM,300,RC,85520,HCPCS,Outpatient,,,118,100.3,,95.82,81.2,,,percent of total billed charges,81.2% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,89.68,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,38.89,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,104.55,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,107.38,91,,,percent of total billed charges,91% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,39.65,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,108.56,92,,,percent of total billed charges,92% of total billed charges,5.98,108.56,
HEPARIN ANTI FACTOR Xa,2000831,CDM,300,RC,85520,HCPCS,Outpatient,,,118,100.3,,95.82,81.2,,,percent of total billed charges,81.2% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,89.68,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,38.89,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,104.55,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,107.38,91,,,percent of total billed charges,91% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,39.65,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,108.56,92,,,percent of total billed charges,92% of total billed charges,5.98,108.56,
LYSOZYME MURAMIDASE,2000468,CDM,301,RC,85549,HCPCS,Outpatient,,,66,56.1,,53.59,81.2,,,percent of total billed charges,81.2% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,50.16,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.75,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,58.48,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,60.06,91,,,percent of total billed charges,91% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,22.18,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,60.72,92,,,percent of total billed charges,92% of total billed charges,11.18,60.72,
PROTHROMBIN TIME,2000119,CDM,305,RC,85610,HCPCS,Outpatient,,,34,28.9,,27.61,81.2,,,percent of total billed charges,81.2% of total billed charges,11.1,32.64,,,percent of total billed charges,32.64% of total billed charges,25.16,74,,,percent of total billed charges,74% of total billed charges,25.16,74,,,percent of total billed charges,74% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,10.88,32,,,percent of total billed charges,32% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,22.78,67,,,percent of total billed charges,67% of total billed charges,22.78,67,,,percent of total billed charges,67% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,25.84,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,11.21,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,30.6,90,,,percent of total billed charges,90% of total billed charges,30.6,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,30.12,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,10.88,32,,,percent of total billed charges,32% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,30.94,91,,,percent of total billed charges,91% of total billed charges,11.1,32.64,,,percent of total billed charges,32.64% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,11.42,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,10.88,32,,,percent of total billed charges,32% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,31.28,92,,,percent of total billed charges,92% of total billed charges,5.98,31.28,
MIXING STUDIES PT,2000423,CDM,305,RC,85611,HCPCS,Outpatient,,,44,37.4,,35.73,81.2,,,percent of total billed charges,81.2% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,33.44,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,14.5,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,39.6,90,,,percent of total billed charges,90% of total billed charges,39.6,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,38.98,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,40.04,91,,,percent of total billed charges,91% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,14.78,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,14.08,32,,,percent of total billed charges,32% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,40.48,92,,,percent of total billed charges,92% of total billed charges,5.98,40.48,
RUSSELL VIPER DILUTE,2000486,CDM,305,RC,85613,HCPCS,Outpatient,,,38,32.3,,30.86,81.2,,,percent of total billed charges,81.2% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,28.88,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.52,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,34.2,90,,,percent of total billed charges,90% of total billed charges,34.2,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,33.67,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,34.58,91,,,percent of total billed charges,91% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,12.77,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,34.96,92,,,percent of total billed charges,92% of total billed charges,5.98,34.96,
ESR SED RATE AUTOMATED,2000055,CDM,305,RC,85652,HCPCS,Outpatient,,,49,41.65,,39.79,81.2,,,percent of total billed charges,81.2% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,37.24,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,16.15,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,44.1,90,,,percent of total billed charges,90% of total billed charges,44.1,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,43.41,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,44.59,91,,,percent of total billed charges,91% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,16.46,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,45.08,92,,,percent of total billed charges,92% of total billed charges,5.23,45.08,
SICKLE CELL SCREEN,2000130,CDM,305,RC,85660,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,5.23,74.52,
DILUTE PROTHROMBIN TIME,2001678,CDM,305,RC,85705,HCPCS,Outpatient,,,39,33.15,,31.67,81.2,,,percent of total billed charges,81.2% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,29.64,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.85,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,34.55,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,35.49,91,,,percent of total billed charges,91% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,13.1,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,35.88,92,,,percent of total billed charges,92% of total billed charges,5.98,35.88,
THROMBOPLASTINS INHIB TISSUE,2000294,CDM,305,RC,85705,HCPCS,Outpatient,,,39,33.15,,31.67,81.2,,,percent of total billed charges,81.2% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,29.64,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.85,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,34.55,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,35.49,91,,,percent of total billed charges,91% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,13.1,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,35.88,92,,,percent of total billed charges,92% of total billed charges,5.98,35.88,
ACTIVATED PTT,2000006,CDM,305,RC,85730,HCPCS,Outpatient,,,63,53.55,,51.16,81.2,,,percent of total billed charges,81.2% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,47.88,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,20.76,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,55.82,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,57.33,91,,,percent of total billed charges,91% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,21.17,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,57.96,92,,,percent of total billed charges,92% of total billed charges,5.98,57.96,
LUPUS ANTICOAGULANT,2000364,CDM,302,RC,85732,HCPCS,Outpatient,,,135,114.75,,109.62,81.2,,,percent of total billed charges,81.2% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,102.6,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,44.5,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,119.61,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,122.85,91,,,percent of total billed charges,91% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,45.36,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,124.2,92,,,percent of total billed charges,92% of total billed charges,5.98,124.2,
MIXING STUDIES PTT,2000367,CDM,305,RC,85732,HCPCS,Outpatient,,,135,114.75,,109.62,81.2,,,percent of total billed charges,81.2% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,102.6,76,,,percent of total billed charges,76% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,44.5,32.96,,,percent of total billed charges,32.96% of total billed charges,6.28,105,,,Fee Schedule,pays based on EAPG rates,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,119.61,88.6,,,percent of total billed charges,88.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,5.98,100,,,Fee Schedule,pays based on EAPG rates,122.85,91,,,percent of total billed charges,91% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,45.36,33.6,,,percent of total billed charges,33.6% of total billed charges,6.16,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,124.2,92,,,percent of total billed charges,92% of total billed charges,5.98,124.2,
VISCOSITY,2000465,CDM,305,RC,85810,HCPCS,Outpatient,,,39,33.15,,31.67,81.2,,,percent of total billed charges,81.2% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,1.9,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,29.64,76,,,percent of total billed charges,76% of total billed charges,1.9,103,,,Fee Schedule,pays based on EAPG rates,12.85,32.96,,,percent of total billed charges,32.96% of total billed charges,1.93,105,,,Fee Schedule,pays based on EAPG rates,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,1.84,100,,,Fee Schedule,pays based on EAPG rates,34.55,88.6,,,percent of total billed charges,88.6% of total billed charges,1.9,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,1.84,100,,,Fee Schedule,pays based on EAPG rates,35.49,91,,,percent of total billed charges,91% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,13.1,33.6,,,percent of total billed charges,33.6% of total billed charges,1.9,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,35.88,92,,,percent of total billed charges,92% of total billed charges,1.84,35.88,
F013-IGG4 PEANUT,2001702,CDM,300,RC,86001,HCPCS,Outpatient,,,25,21.25,,20.3,81.2,,,percent of total billed charges,81.2% of total billed charges,8.16,32.64,,,percent of total billed charges,32.64% of total billed charges,18.5,74,,,percent of total billed charges,74% of total billed charges,18.5,74,,,percent of total billed charges,74% of total billed charges,8,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8,32,,,percent of total billed charges,32% of total billed charges,17.75,71,,,percent of total billed charges,71% of total billed charges,17.75,71,,,percent of total billed charges,71% of total billed charges,16.75,67,,,percent of total billed charges,67% of total billed charges,16.75,67,,,percent of total billed charges,67% of total billed charges,17.75,71,,,percent of total billed charges,71% of total billed charges,19,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.24,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,22.5,90,,,percent of total billed charges,90% of total billed charges,22.5,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,22.15,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8,32,,,percent of total billed charges,32% of total billed charges,20,80,,,percent of total billed charges,80% of total billed charges,20,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,22.75,91,,,percent of total billed charges,91% of total billed charges,8.16,32.64,,,percent of total billed charges,32.64% of total billed charges,8,32,,,percent of total billed charges,32% of total billed charges,8.4,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8,32,,,percent of total billed charges,32% of total billed charges,8,32,,,percent of total billed charges,32% of total billed charges,23,92,,,percent of total billed charges,92% of total billed charges,8,23,
ALTERNARIA,2001757,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
C201-IGE CEPHALOSPORIN-DRUG,2001129,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
D002-IGE D FARINAE,2001772,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
E001-IGE CAT DANDER,2001764,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
E005-IGE DOG DANDER,2001763,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
E072-IGE MOUSE URINE,2001774,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F002-IGE MILK,2000459,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F004-IGE WHEAT,2001738,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F008-IGE CORN,2001739,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F013-IGE PEANUT,2001119,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F014-IGE SOYBEAN,2001737,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F017-IGE HAZELNUT/FILBERT,2001130,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F018-IGE BRAZIL NUT,2001121,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F020-IGE ALMOND,2001132,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F023-IGE CRAB,2001733,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F024-IGE SHRIMP,2001731,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F026-IGE PORK,2001761,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F027-IGE BEEF,2001759,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F044-IGE STRAWBERRY,2001133,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F080-IGE LOBSTER,2001734,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F093-IGE CHOCOLATE/CACAO,2001127,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F201-IGE PECAN NUT,2001120,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F202-IGE CASHEW NUT,2001118,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F203-IGE PISTACHIO NUT,2001126,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F207-IGE CLAM,2001736,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
"F245-IGE EGG, WHOLE",2001760,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F253-IGE PINON (PINE NUT),2001128,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F256-IGE WALNUT FOOD,2001122,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F290-IGE OYSTER,2001735,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F299-IGE SWEET CHESTNUT,2001124,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F338-IGE SCALLOP,2001732,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F352-IGE ARA H 8,2001705,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F422-IGE ARA H 1,2001704,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F423-IGE ARA H 2,2001706,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F424-IGE ARA H 3,2001703,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
F427-IGE ARA H 9,2001707,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
G002-IGE BERMUDA GRASS,2001769,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
"G008-IGE BLUEGRASS, KENTUCKY",2001770,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
K082-IGE LATEX,2001123,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
M006-IGE ALTERNARIA ALTERNATA,2001767,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
RAST ALLERGEN,2000430,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
RAST X5,2001373,CDM,302,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
"T007-IGE OAK, WHITE",2001771,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
T008-IGE AMERICAN ELM,2001768,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
W001-IGE D PTERONYSSINUS,2001766,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
"W001-IGE RAGWEED, SHORT",2001765,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
"W009-IGE PLANTAIN, ENGLISH",2001773,CDM,300,RC,86003,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
FX02-IGE FOOD MIX (SEAFOODS),2001762,CDM,300,RC,86005,HCPCS,Outpatient,,,34,28.9,,27.61,81.2,,,percent of total billed charges,81.2% of total billed charges,11.1,32.64,,,percent of total billed charges,32.64% of total billed charges,25.16,74,,,percent of total billed charges,74% of total billed charges,25.16,74,,,percent of total billed charges,74% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,10.88,32,,,percent of total billed charges,32% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,22.78,67,,,percent of total billed charges,67% of total billed charges,22.78,67,,,percent of total billed charges,67% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,25.84,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,11.21,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,30.6,90,,,percent of total billed charges,90% of total billed charges,30.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,30.12,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,10.88,32,,,percent of total billed charges,32% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,30.94,91,,,percent of total billed charges,91% of total billed charges,11.1,32.64,,,percent of total billed charges,32.64% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,11.42,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,10.88,32,,,percent of total billed charges,32% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,31.28,92,,,percent of total billed charges,92% of total billed charges,10.88,31.28,
PLATELET (ALLO) ANTIBODY PROFILE,2001179,CDM,302,RC,86022,HCPCS,Outpatient,,,336,285.6,,272.83,81.2,,,percent of total billed charges,81.2% of total billed charges,109.67,32.64,,,percent of total billed charges,32.64% of total billed charges,248.64,74,,,percent of total billed charges,74% of total billed charges,248.64,74,,,percent of total billed charges,74% of total billed charges,107.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,107.52,32,,,percent of total billed charges,32% of total billed charges,238.56,71,,,percent of total billed charges,71% of total billed charges,238.56,71,,,percent of total billed charges,71% of total billed charges,225.12,67,,,percent of total billed charges,67% of total billed charges,225.12,67,,,percent of total billed charges,67% of total billed charges,238.56,71,,,percent of total billed charges,71% of total billed charges,255.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,110.75,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,302.4,90,,,percent of total billed charges,90% of total billed charges,302.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,297.7,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,107.52,32,,,percent of total billed charges,32% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,305.76,91,,,percent of total billed charges,91% of total billed charges,109.67,32.64,,,percent of total billed charges,32.64% of total billed charges,107.52,32,,,percent of total billed charges,32% of total billed charges,112.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,107.52,32,,,percent of total billed charges,32% of total billed charges,107.52,32,,,percent of total billed charges,32% of total billed charges,309.12,92,,,percent of total billed charges,92% of total billed charges,14.22,309.12,
PLATLET AB AUTO,2000490,CDM,305,RC,86022,HCPCS,Outpatient,,,336,285.6,,272.83,81.2,,,percent of total billed charges,81.2% of total billed charges,109.67,32.64,,,percent of total billed charges,32.64% of total billed charges,248.64,74,,,percent of total billed charges,74% of total billed charges,248.64,74,,,percent of total billed charges,74% of total billed charges,107.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,107.52,32,,,percent of total billed charges,32% of total billed charges,238.56,71,,,percent of total billed charges,71% of total billed charges,238.56,71,,,percent of total billed charges,71% of total billed charges,225.12,67,,,percent of total billed charges,67% of total billed charges,225.12,67,,,percent of total billed charges,67% of total billed charges,238.56,71,,,percent of total billed charges,71% of total billed charges,255.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,110.75,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,302.4,90,,,percent of total billed charges,90% of total billed charges,302.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,297.7,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,107.52,32,,,percent of total billed charges,32% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,268.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,305.76,91,,,percent of total billed charges,91% of total billed charges,109.67,32.64,,,percent of total billed charges,32.64% of total billed charges,107.52,32,,,percent of total billed charges,32% of total billed charges,112.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,107.52,32,,,percent of total billed charges,32% of total billed charges,107.52,32,,,percent of total billed charges,32% of total billed charges,309.12,92,,,percent of total billed charges,92% of total billed charges,14.22,309.12,
HEPARIN ASSOCIATED ANTIBODY,2000554,CDM,300,RC,86023,HCPCS,Outpatient,,,389,330.65,,315.87,81.2,,,percent of total billed charges,81.2% of total billed charges,126.97,32.64,,,percent of total billed charges,32.64% of total billed charges,287.86,74,,,percent of total billed charges,74% of total billed charges,287.86,74,,,percent of total billed charges,74% of total billed charges,124.48,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,124.48,32,,,percent of total billed charges,32% of total billed charges,276.19,71,,,percent of total billed charges,71% of total billed charges,276.19,71,,,percent of total billed charges,71% of total billed charges,260.63,67,,,percent of total billed charges,67% of total billed charges,260.63,67,,,percent of total billed charges,67% of total billed charges,276.19,71,,,percent of total billed charges,71% of total billed charges,295.64,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,128.21,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,350.1,90,,,percent of total billed charges,90% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,344.65,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,124.48,32,,,percent of total billed charges,32% of total billed charges,311.2,80,,,percent of total billed charges,80% of total billed charges,311.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,353.99,91,,,percent of total billed charges,91% of total billed charges,126.97,32.64,,,percent of total billed charges,32.64% of total billed charges,124.48,32,,,percent of total billed charges,32% of total billed charges,130.7,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,124.48,32,,,percent of total billed charges,32% of total billed charges,124.48,32,,,percent of total billed charges,32% of total billed charges,357.88,92,,,percent of total billed charges,92% of total billed charges,14.22,357.88,
ANA,2000013,CDM,302,RC,86038,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,14.22,91.08,
ANA DIRECT,2001422,CDM,302,RC,86038,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,14.22,91.08,
ANA REFLEX IF POSITIVE,2001139,CDM,302,RC,86038,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,14.22,91.08,
ASO TITER,2000015,CDM,302,RC,86060,HCPCS,Outpatient,,,108,91.8,,87.7,81.2,,,percent of total billed charges,81.2% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,79.92,74,,,percent of total billed charges,74% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,72.36,67,,,percent of total billed charges,67% of total billed charges,76.68,71,,,percent of total billed charges,71% of total billed charges,82.08,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.6,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,95.69,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,86.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,98.28,91,,,percent of total billed charges,91% of total billed charges,35.25,32.64,,,percent of total billed charges,32.64% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,36.29,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,34.56,32,,,percent of total billed charges,32% of total billed charges,34.56,32,,,percent of total billed charges,32% of total billed charges,99.36,92,,,percent of total billed charges,92% of total billed charges,14.22,99.36,
CRP,2000039,CDM,302,RC,86140,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,14.22,79.12,
CRP CARDIAC RISK/HIGH SENS,2000729,CDM,300,RC,86141,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,14.22,79.12,
BETA 2 GLYCOPROTEIN IGG,2001697,CDM,300,RC,86146,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,11.18,94.76,
BETA 2 GLYCOPROTEIN IGM,2001698,CDM,300,RC,86146,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,11.18,94.76,
ANTI PHOSPHOLIP IGG/IGM,2000633,CDM,302,RC,86147,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,17.65,91.08,
"ANTICARDIOLIPIN AB IGA, QN",2001137,CDM,302,RC,86147,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,17.65,91.08,
"ANTICARDIOLIPIN AB IGG, QN",2001170,CDM,302,RC,86147,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,17.65,91.08,
"ANTICARDIOLIPIN AB IGM,QN",2000886,CDM,302,RC,86147,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,17.65,91.08,
PHOSPHOLIPID,2000254,CDM,302,RC,86147,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,17.65,91.08,
"PHOSPHADITYLSERINE IgG,IgM,IgA",2000860,CDM,300,RC,86148,HCPCS,Outpatient,,,278,236.3,,225.74,81.2,,,percent of total billed charges,81.2% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,211.28,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,91.63,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,250.2,90,,,percent of total billed charges,90% of total billed charges,250.2,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,246.31,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,252.98,91,,,percent of total billed charges,91% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,93.41,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,255.76,92,,,percent of total billed charges,92% of total billed charges,11.18,255.76,
C ESTERASE INHIBITOR,2000669,CDM,302,RC,86160,HCPCS,Outpatient,,,55,46.75,,44.66,81.2,,,percent of total billed charges,81.2% of total billed charges,17.95,32.64,,,percent of total billed charges,32.64% of total billed charges,40.7,74,,,percent of total billed charges,74% of total billed charges,40.7,74,,,percent of total billed charges,74% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,36.85,67,,,percent of total billed charges,67% of total billed charges,36.85,67,,,percent of total billed charges,67% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,41.8,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,18.13,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,49.5,90,,,percent of total billed charges,90% of total billed charges,49.5,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,48.73,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,44,80,,,percent of total billed charges,80% of total billed charges,44,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,50.05,91,,,percent of total billed charges,91% of total billed charges,17.95,32.64,,,percent of total billed charges,32.64% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,18.48,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,50.6,92,,,percent of total billed charges,92% of total billed charges,14.22,50.6,
C2 COMPLEMENT,2000028,CDM,302,RC,86160,HCPCS,Outpatient,,,55,46.75,,44.66,81.2,,,percent of total billed charges,81.2% of total billed charges,17.95,32.64,,,percent of total billed charges,32.64% of total billed charges,40.7,74,,,percent of total billed charges,74% of total billed charges,40.7,74,,,percent of total billed charges,74% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,36.85,67,,,percent of total billed charges,67% of total billed charges,36.85,67,,,percent of total billed charges,67% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,41.8,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,18.13,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,49.5,90,,,percent of total billed charges,90% of total billed charges,49.5,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,48.73,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,44,80,,,percent of total billed charges,80% of total billed charges,44,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,50.05,91,,,percent of total billed charges,91% of total billed charges,17.95,32.64,,,percent of total billed charges,32.64% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,18.48,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,50.6,92,,,percent of total billed charges,92% of total billed charges,14.22,50.6,
C3 COMPLEMENT,2000259,CDM,302,RC,86160,HCPCS,Outpatient,,,55,46.75,,44.66,81.2,,,percent of total billed charges,81.2% of total billed charges,17.95,32.64,,,percent of total billed charges,32.64% of total billed charges,40.7,74,,,percent of total billed charges,74% of total billed charges,40.7,74,,,percent of total billed charges,74% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,36.85,67,,,percent of total billed charges,67% of total billed charges,36.85,67,,,percent of total billed charges,67% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,41.8,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,18.13,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,49.5,90,,,percent of total billed charges,90% of total billed charges,49.5,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,48.73,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,44,80,,,percent of total billed charges,80% of total billed charges,44,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,50.05,91,,,percent of total billed charges,91% of total billed charges,17.95,32.64,,,percent of total billed charges,32.64% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,18.48,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,50.6,92,,,percent of total billed charges,92% of total billed charges,14.22,50.6,
C4 COMPLIMENT,2000260,CDM,302,RC,86160,HCPCS,Outpatient,,,55,46.75,,44.66,81.2,,,percent of total billed charges,81.2% of total billed charges,17.95,32.64,,,percent of total billed charges,32.64% of total billed charges,40.7,74,,,percent of total billed charges,74% of total billed charges,40.7,74,,,percent of total billed charges,74% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,36.85,67,,,percent of total billed charges,67% of total billed charges,36.85,67,,,percent of total billed charges,67% of total billed charges,39.05,71,,,percent of total billed charges,71% of total billed charges,41.8,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,18.13,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,49.5,90,,,percent of total billed charges,90% of total billed charges,49.5,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,48.73,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,44,80,,,percent of total billed charges,80% of total billed charges,44,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,50.05,91,,,percent of total billed charges,91% of total billed charges,17.95,32.64,,,percent of total billed charges,32.64% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,18.48,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.6,32,,,percent of total billed charges,32% of total billed charges,17.6,32,,,percent of total billed charges,32% of total billed charges,50.6,92,,,percent of total billed charges,92% of total billed charges,14.22,50.6,
C1 FUNCTION,2000689,CDM,302,RC,86161,HCPCS,Outpatient,,,303,257.55,,246.04,81.2,,,percent of total billed charges,81.2% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,230.28,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,99.87,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,272.7,90,,,percent of total billed charges,90% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,268.46,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,275.73,91,,,percent of total billed charges,91% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,101.81,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,278.76,92,,,percent of total billed charges,92% of total billed charges,14.22,278.76,
CH50 COMPLEMENT,2000261,CDM,302,RC,86162,HCPCS,Outpatient,,,65,55.25,,52.78,81.2,,,percent of total billed charges,81.2% of total billed charges,21.22,32.64,,,percent of total billed charges,32.64% of total billed charges,48.1,74,,,percent of total billed charges,74% of total billed charges,48.1,74,,,percent of total billed charges,74% of total billed charges,20.8,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.8,32,,,percent of total billed charges,32% of total billed charges,46.15,71,,,percent of total billed charges,71% of total billed charges,46.15,71,,,percent of total billed charges,71% of total billed charges,43.55,67,,,percent of total billed charges,67% of total billed charges,43.55,67,,,percent of total billed charges,67% of total billed charges,46.15,71,,,percent of total billed charges,71% of total billed charges,49.4,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.42,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,58.5,90,,,percent of total billed charges,90% of total billed charges,58.5,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,57.59,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.8,32,,,percent of total billed charges,32% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,52,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,59.15,91,,,percent of total billed charges,91% of total billed charges,21.22,32.64,,,percent of total billed charges,32.64% of total billed charges,20.8,32,,,percent of total billed charges,32% of total billed charges,21.84,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.8,32,,,percent of total billed charges,32% of total billed charges,20.8,32,,,percent of total billed charges,32% of total billed charges,59.8,92,,,percent of total billed charges,92% of total billed charges,14.22,59.8,
CYCLIC CITRULLINATED PEPTIDE,2000875,CDM,300,RC,86200,HCPCS,Outpatient,,,197,167.45,,159.96,81.2,,,percent of total billed charges,81.2% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,145.78,74,,,percent of total billed charges,74% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,131.99,67,,,percent of total billed charges,67% of total billed charges,139.87,71,,,percent of total billed charges,71% of total billed charges,149.72,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,64.93,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,174.54,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,157.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,179.27,91,,,percent of total billed charges,91% of total billed charges,64.3,32.64,,,percent of total billed charges,32.64% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,66.19,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,63.04,32,,,percent of total billed charges,32% of total billed charges,63.04,32,,,percent of total billed charges,32% of total billed charges,181.24,92,,,percent of total billed charges,92% of total billed charges,14.22,181.24,
ANTI DNA DOUBLE STRAND,2000308,CDM,300,RC,86225,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,14.22,85.56,
ANTI DNA SINGLE STRAND,2000629,CDM,302,RC,86226,HCPCS,Outpatient,,,37,31.45,,30.04,81.2,,,percent of total billed charges,81.2% of total billed charges,12.08,32.64,,,percent of total billed charges,32.64% of total billed charges,27.38,74,,,percent of total billed charges,74% of total billed charges,27.38,74,,,percent of total billed charges,74% of total billed charges,11.84,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,11.84,32,,,percent of total billed charges,32% of total billed charges,26.27,71,,,percent of total billed charges,71% of total billed charges,26.27,71,,,percent of total billed charges,71% of total billed charges,24.79,67,,,percent of total billed charges,67% of total billed charges,24.79,67,,,percent of total billed charges,67% of total billed charges,26.27,71,,,percent of total billed charges,71% of total billed charges,28.12,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.2,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,33.3,90,,,percent of total billed charges,90% of total billed charges,33.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,32.78,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,11.84,32,,,percent of total billed charges,32% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,33.67,91,,,percent of total billed charges,91% of total billed charges,12.08,32.64,,,percent of total billed charges,32.64% of total billed charges,11.84,32,,,percent of total billed charges,32% of total billed charges,12.43,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,11.84,32,,,percent of total billed charges,32% of total billed charges,11.84,32,,,percent of total billed charges,32% of total billed charges,34.04,92,,,percent of total billed charges,92% of total billed charges,11.84,34.04,
ANTI CENTROMERE,2000428,CDM,301,RC,86235,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
ANTI JO 1 ANTIBODY,2000646,CDM,302,RC,86235,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
ANTI RNP,2000309,CDM,302,RC,86235,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
ANTI SMITH,2000317,CDM,302,RC,86235,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
ANTI SSB,2000316,CDM,302,RC,86235,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
ANTICHROMETIN ANTIBODIES,2001692,CDM,300,RC,86235,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
SCLERODERMA AB SCI 70,2000311,CDM,302,RC,86235,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
SJOGREN'S ANTI-SSA,2001136,CDM,302,RC,86235,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
SMITH/RNP ANTIBODIES,2001695,CDM,302,RC,86235,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
"ANTI ENDOMYSIAL, IgA",2000687,CDM,301,RC,86255,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
ANTI HISTONE,2000312,CDM,302,RC,86255,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
ANTIADRENAL  ABS QUANTITATIVE,2001752,CDM,302,RC,86255,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
CELIAC DX PROFILE,2000730,CDM,300,RC,86255,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
FLUORESCENT ANTIBODY,2000516,CDM,302,RC,86255,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
NSA NEUTROPHIL SPECIFIC ANTIB,2000862,CDM,300,RC,86255,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
ANTI MITOCHONDRIAL ANTIBODY QT,2000182,CDM,302,RC,86256,HCPCS,Outpatient,,,326,277.1,,264.71,81.2,,,percent of total billed charges,81.2% of total billed charges,106.41,32.64,,,percent of total billed charges,32.64% of total billed charges,241.24,74,,,percent of total billed charges,74% of total billed charges,241.24,74,,,percent of total billed charges,74% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,218.42,67,,,percent of total billed charges,67% of total billed charges,218.42,67,,,percent of total billed charges,67% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,247.76,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,107.45,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,293.4,90,,,percent of total billed charges,90% of total billed charges,293.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,288.84,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,260.8,80,,,percent of total billed charges,80% of total billed charges,260.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,296.66,91,,,percent of total billed charges,91% of total billed charges,106.41,32.64,,,percent of total billed charges,32.64% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,109.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,299.92,92,,,percent of total billed charges,92% of total billed charges,14.22,299.92,
ANTINEUTROPHIL CYTOPLAMIC  ANTIBODIES,2000325,CDM,302,RC,86256,HCPCS,Outpatient,,,326,277.1,,264.71,81.2,,,percent of total billed charges,81.2% of total billed charges,106.41,32.64,,,percent of total billed charges,32.64% of total billed charges,241.24,74,,,percent of total billed charges,74% of total billed charges,241.24,74,,,percent of total billed charges,74% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,218.42,67,,,percent of total billed charges,67% of total billed charges,218.42,67,,,percent of total billed charges,67% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,247.76,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,107.45,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,293.4,90,,,percent of total billed charges,90% of total billed charges,293.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,288.84,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,260.8,80,,,percent of total billed charges,80% of total billed charges,260.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,296.66,91,,,percent of total billed charges,91% of total billed charges,106.41,32.64,,,percent of total billed charges,32.64% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,109.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,299.92,92,,,percent of total billed charges,92% of total billed charges,14.22,299.92,
PARANEOPLASTIC PROFILE 1,2001497,CDM,302,RC,86256,HCPCS,Outpatient,,,326,277.1,,264.71,81.2,,,percent of total billed charges,81.2% of total billed charges,106.41,32.64,,,percent of total billed charges,32.64% of total billed charges,241.24,74,,,percent of total billed charges,74% of total billed charges,241.24,74,,,percent of total billed charges,74% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,218.42,67,,,percent of total billed charges,67% of total billed charges,218.42,67,,,percent of total billed charges,67% of total billed charges,231.46,71,,,percent of total billed charges,71% of total billed charges,247.76,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,107.45,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,293.4,90,,,percent of total billed charges,90% of total billed charges,293.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,288.84,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,260.8,80,,,percent of total billed charges,80% of total billed charges,260.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,296.66,91,,,percent of total billed charges,91% of total billed charges,106.41,32.64,,,percent of total billed charges,32.64% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,109.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,104.32,32,,,percent of total billed charges,32% of total billed charges,104.32,32,,,percent of total billed charges,32% of total billed charges,299.92,92,,,percent of total billed charges,92% of total billed charges,14.22,299.92,
CA 15 3,2000531,CDM,302,RC,86300,HCPCS,Outpatient,,,63,53.55,,51.16,81.2,,,percent of total billed charges,81.2% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,47.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,20.76,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,55.82,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,57.33,91,,,percent of total billed charges,91% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,21.17,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,57.96,92,,,percent of total billed charges,92% of total billed charges,10.25,57.96,
CA 27.29,2000529,CDM,302,RC,86300,HCPCS,Outpatient,,,63,53.55,,51.16,81.2,,,percent of total billed charges,81.2% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,47.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,20.76,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,55.82,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,57.33,91,,,percent of total billed charges,91% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,21.17,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,57.96,92,,,percent of total billed charges,92% of total billed charges,10.25,57.96,
CA19 9,2000306,CDM,302,RC,86301,HCPCS,Outpatient,,,48,40.8,,38.98,81.2,,,percent of total billed charges,81.2% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,35.52,74,,,percent of total billed charges,74% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,32.16,67,,,percent of total billed charges,67% of total billed charges,34.08,71,,,percent of total billed charges,71% of total billed charges,36.48,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,15.82,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,43.2,90,,,percent of total billed charges,90% of total billed charges,43.2,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,42.53,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,38.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,43.68,91,,,percent of total billed charges,91% of total billed charges,15.67,32.64,,,percent of total billed charges,32.64% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,16.13,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,15.36,32,,,percent of total billed charges,32% of total billed charges,15.36,32,,,percent of total billed charges,32% of total billed charges,44.16,92,,,percent of total billed charges,92% of total billed charges,10.25,44.16,
CANCER ANTIGEN 125,2000206,CDM,302,RC,86304,HCPCS,Outpatient,,,125,106.25,,101.5,81.2,,,percent of total billed charges,81.2% of total billed charges,40.8,32.64,,,percent of total billed charges,32.64% of total billed charges,92.5,74,,,percent of total billed charges,74% of total billed charges,92.5,74,,,percent of total billed charges,74% of total billed charges,40,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,40,32,,,percent of total billed charges,32% of total billed charges,88.75,71,,,percent of total billed charges,71% of total billed charges,88.75,71,,,percent of total billed charges,71% of total billed charges,83.75,67,,,percent of total billed charges,67% of total billed charges,83.75,67,,,percent of total billed charges,67% of total billed charges,88.75,71,,,percent of total billed charges,71% of total billed charges,95,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,41.2,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,112.5,90,,,percent of total billed charges,90% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,110.75,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,40,32,,,percent of total billed charges,32% of total billed charges,100,80,,,percent of total billed charges,80% of total billed charges,100,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,113.75,91,,,percent of total billed charges,91% of total billed charges,40.8,32.64,,,percent of total billed charges,32.64% of total billed charges,40,32,,,percent of total billed charges,32% of total billed charges,42,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,40,32,,,percent of total billed charges,32% of total billed charges,40,32,,,percent of total billed charges,32% of total billed charges,115,92,,,percent of total billed charges,92% of total billed charges,10.25,115,
MONO QUALITATIVE WITH REFLEX,2001636,CDM,302,RC,86308,HCPCS,Outpatient,,,183,155.55,,148.6,81.2,,,percent of total billed charges,81.2% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,139.08,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,60.32,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,164.7,90,,,percent of total billed charges,90% of total billed charges,164.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,162.14,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,166.53,91,,,percent of total billed charges,91% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,61.49,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,168.36,92,,,percent of total billed charges,92% of total billed charges,14.22,168.36,
MONO TEST,2000103,CDM,302,RC,86308,HCPCS,Outpatient,,,183,155.55,,148.6,81.2,,,percent of total billed charges,81.2% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,139.08,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,60.32,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,164.7,90,,,percent of total billed charges,90% of total billed charges,164.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,162.14,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,166.53,91,,,percent of total billed charges,91% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,61.49,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,168.36,92,,,percent of total billed charges,92% of total billed charges,14.22,168.36,
CHROMOGRANIN A,2001221,CDM,302,RC,86316,HCPCS,Outpatient,,,205,174.25,,166.46,81.2,,,percent of total billed charges,81.2% of total billed charges,66.91,32.64,,,percent of total billed charges,32.64% of total billed charges,151.7,74,,,percent of total billed charges,74% of total billed charges,151.7,74,,,percent of total billed charges,74% of total billed charges,65.6,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,65.6,32,,,percent of total billed charges,32% of total billed charges,145.55,71,,,percent of total billed charges,71% of total billed charges,145.55,71,,,percent of total billed charges,71% of total billed charges,137.35,67,,,percent of total billed charges,67% of total billed charges,137.35,67,,,percent of total billed charges,67% of total billed charges,145.55,71,,,percent of total billed charges,71% of total billed charges,155.8,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,67.57,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,184.5,90,,,percent of total billed charges,90% of total billed charges,184.5,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,181.63,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,65.6,32,,,percent of total billed charges,32% of total billed charges,164,80,,,percent of total billed charges,80% of total billed charges,164,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,186.55,91,,,percent of total billed charges,91% of total billed charges,66.91,32.64,,,percent of total billed charges,32.64% of total billed charges,65.6,32,,,percent of total billed charges,32% of total billed charges,68.88,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,65.6,32,,,percent of total billed charges,32% of total billed charges,65.6,32,,,percent of total billed charges,32% of total billed charges,188.6,92,,,percent of total billed charges,92% of total billed charges,11.18,188.6,
HEPATITIS B SURFACE AB QUANT,2001415,CDM,302,RC,86317,HCPCS,Outpatient,,,76,64.6,,61.71,81.2,,,percent of total billed charges,81.2% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,57.76,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.05,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,67.34,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.16,91,,,percent of total billed charges,91% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,25.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,69.92,92,,,percent of total billed charges,92% of total billed charges,14.22,69.92,
IMMUNO ELECTROPHORESIS SP FL,2000083,CDM,302,RC,86325,HCPCS,Outpatient,,,131,111.35,,106.37,81.2,,,percent of total billed charges,81.2% of total billed charges,42.76,32.64,,,percent of total billed charges,32.64% of total billed charges,96.94,74,,,percent of total billed charges,74% of total billed charges,96.94,74,,,percent of total billed charges,74% of total billed charges,41.92,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.92,32,,,percent of total billed charges,32% of total billed charges,93.01,71,,,percent of total billed charges,71% of total billed charges,93.01,71,,,percent of total billed charges,71% of total billed charges,87.77,67,,,percent of total billed charges,67% of total billed charges,87.77,67,,,percent of total billed charges,67% of total billed charges,93.01,71,,,percent of total billed charges,71% of total billed charges,99.56,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.18,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,117.9,90,,,percent of total billed charges,90% of total billed charges,117.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,116.07,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.92,32,,,percent of total billed charges,32% of total billed charges,104.8,80,,,percent of total billed charges,80% of total billed charges,104.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,119.21,91,,,percent of total billed charges,91% of total billed charges,42.76,32.64,,,percent of total billed charges,32.64% of total billed charges,41.92,32,,,percent of total billed charges,32% of total billed charges,44.02,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.92,32,,,percent of total billed charges,32% of total billed charges,41.92,32,,,percent of total billed charges,32% of total billed charges,120.52,92,,,percent of total billed charges,92% of total billed charges,11.18,120.52,
IMMUNO ELECTROPHORESIS URINE,2000084,CDM,302,RC,86325,HCPCS,Outpatient,,,131,111.35,,106.37,81.2,,,percent of total billed charges,81.2% of total billed charges,42.76,32.64,,,percent of total billed charges,32.64% of total billed charges,96.94,74,,,percent of total billed charges,74% of total billed charges,96.94,74,,,percent of total billed charges,74% of total billed charges,41.92,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.92,32,,,percent of total billed charges,32% of total billed charges,93.01,71,,,percent of total billed charges,71% of total billed charges,93.01,71,,,percent of total billed charges,71% of total billed charges,87.77,67,,,percent of total billed charges,67% of total billed charges,87.77,67,,,percent of total billed charges,67% of total billed charges,93.01,71,,,percent of total billed charges,71% of total billed charges,99.56,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,43.18,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,117.9,90,,,percent of total billed charges,90% of total billed charges,117.9,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,116.07,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.92,32,,,percent of total billed charges,32% of total billed charges,104.8,80,,,percent of total billed charges,80% of total billed charges,104.8,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,119.21,91,,,percent of total billed charges,91% of total billed charges,42.76,32.64,,,percent of total billed charges,32.64% of total billed charges,41.92,32,,,percent of total billed charges,32% of total billed charges,44.02,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,41.92,32,,,percent of total billed charges,32% of total billed charges,41.92,32,,,percent of total billed charges,32% of total billed charges,120.52,92,,,percent of total billed charges,92% of total billed charges,11.18,120.52,
C1Q QUANTITATIVE,2000415,CDM,302,RC,86332,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,16,46,
IMMUNO ELECTROPHORESIS SERUM,2000085,CDM,302,RC,86334,HCPCS,Outpatient,,,176,149.6,,142.91,81.2,,,percent of total billed charges,81.2% of total billed charges,57.45,32.64,,,percent of total billed charges,32.64% of total billed charges,130.24,74,,,percent of total billed charges,74% of total billed charges,130.24,74,,,percent of total billed charges,74% of total billed charges,56.32,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,56.32,32,,,percent of total billed charges,32% of total billed charges,124.96,71,,,percent of total billed charges,71% of total billed charges,124.96,71,,,percent of total billed charges,71% of total billed charges,117.92,67,,,percent of total billed charges,67% of total billed charges,117.92,67,,,percent of total billed charges,67% of total billed charges,124.96,71,,,percent of total billed charges,71% of total billed charges,133.76,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,58.01,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,158.4,90,,,percent of total billed charges,90% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,155.94,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,56.32,32,,,percent of total billed charges,32% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,140.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,160.16,91,,,percent of total billed charges,91% of total billed charges,57.45,32.64,,,percent of total billed charges,32.64% of total billed charges,56.32,32,,,percent of total billed charges,32% of total billed charges,59.14,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,56.32,32,,,percent of total billed charges,32% of total billed charges,56.32,32,,,percent of total billed charges,32% of total billed charges,161.92,92,,,percent of total billed charges,92% of total billed charges,14.22,161.92,
URINE  RANDOM IMMUNO ELECT/PROTEIN,2001161,CDM,302,RC,86335,HCPCS,Outpatient,,,119,101.15,,96.63,81.2,,,percent of total billed charges,81.2% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,90.44,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,39.22,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,105.43,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,108.29,91,,,percent of total billed charges,91% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,39.98,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,109.48,92,,,percent of total billed charges,92% of total billed charges,17.65,109.48,
INHIBIN A,2000891,CDM,300,RC,86336,HCPCS,Outpatient,,,440,374,,357.28,81.2,,,percent of total billed charges,81.2% of total billed charges,143.62,32.64,,,percent of total billed charges,32.64% of total billed charges,325.6,74,,,percent of total billed charges,74% of total billed charges,325.6,74,,,percent of total billed charges,74% of total billed charges,140.8,32,,,percent of total billed charges,32% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,140.8,32,,,percent of total billed charges,32% of total billed charges,312.4,71,,,percent of total billed charges,71% of total billed charges,312.4,71,,,percent of total billed charges,71% of total billed charges,294.8,67,,,percent of total billed charges,67% of total billed charges,294.8,67,,,percent of total billed charges,67% of total billed charges,312.4,71,,,percent of total billed charges,71% of total billed charges,334.4,76,,,percent of total billed charges,76% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,145.02,32.96,,,percent of total billed charges,32.96% of total billed charges,11.74,105,,,Fee Schedule,pays based on EAPG rates,396,90,,,percent of total billed charges,90% of total billed charges,396,90,,,percent of total billed charges,90% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,389.84,88.6,,,percent of total billed charges,88.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,140.8,32,,,percent of total billed charges,32% of total billed charges,352,80,,,percent of total billed charges,80% of total billed charges,352,80,,,percent of total billed charges,80% of total billed charges,11.18,100,,,Fee Schedule,pays based on EAPG rates,400.4,91,,,percent of total billed charges,91% of total billed charges,143.62,32.64,,,percent of total billed charges,32.64% of total billed charges,140.8,32,,,percent of total billed charges,32% of total billed charges,147.84,33.6,,,percent of total billed charges,33.6% of total billed charges,11.51,103,,,Fee Schedule,pays based on EAPG rates,140.8,32,,,percent of total billed charges,32% of total billed charges,140.8,32,,,percent of total billed charges,32% of total billed charges,404.8,92,,,percent of total billed charges,92% of total billed charges,11.18,404.8,
INSULIN AUTO ANTIBODY,2000091,CDM,301,RC,86337,HCPCS,Outpatient,,,169,143.65,,137.23,81.2,,,percent of total billed charges,81.2% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,125.06,74,,,percent of total billed charges,74% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,113.23,67,,,percent of total billed charges,67% of total billed charges,119.99,71,,,percent of total billed charges,71% of total billed charges,128.44,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,55.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,152.1,90,,,percent of total billed charges,90% of total billed charges,152.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,149.73,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,135.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,153.79,91,,,percent of total billed charges,91% of total billed charges,55.16,32.64,,,percent of total billed charges,32.64% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,56.78,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,54.08,32,,,percent of total billed charges,32% of total billed charges,54.08,32,,,percent of total billed charges,32% of total billed charges,155.48,92,,,percent of total billed charges,92% of total billed charges,13.55,155.48,
INTRINSIC ANTIBODY,2000864,CDM,300,RC,86340,HCPCS,Outpatient,,,219,186.15,,177.83,81.2,,,percent of total billed charges,81.2% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,162.06,74,,,percent of total billed charges,74% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,146.73,67,,,percent of total billed charges,67% of total billed charges,155.49,71,,,percent of total billed charges,71% of total billed charges,166.44,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,72.18,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,197.1,90,,,percent of total billed charges,90% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,194.03,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,175.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,199.29,91,,,percent of total billed charges,91% of total billed charges,71.48,32.64,,,percent of total billed charges,32.64% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,73.58,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,70.08,32,,,percent of total billed charges,32% of total billed charges,70.08,32,,,percent of total billed charges,32% of total billed charges,201.48,92,,,percent of total billed charges,92% of total billed charges,13.55,201.48,
CD4 CD8 RATIO PROFILE,2000355,CDM,302,RC,86360,HCPCS,Outpatient,,,499,424.15,,405.19,81.2,,,percent of total billed charges,81.2% of total billed charges,162.87,32.64,,,percent of total billed charges,32.64% of total billed charges,369.26,74,,,percent of total billed charges,74% of total billed charges,369.26,74,,,percent of total billed charges,74% of total billed charges,159.68,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,159.68,32,,,percent of total billed charges,32% of total billed charges,354.29,71,,,percent of total billed charges,71% of total billed charges,354.29,71,,,percent of total billed charges,71% of total billed charges,334.33,67,,,percent of total billed charges,67% of total billed charges,334.33,67,,,percent of total billed charges,67% of total billed charges,354.29,71,,,percent of total billed charges,71% of total billed charges,379.24,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,164.47,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,449.1,90,,,percent of total billed charges,90% of total billed charges,449.1,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,442.11,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,159.68,32,,,percent of total billed charges,32% of total billed charges,399.2,80,,,percent of total billed charges,80% of total billed charges,399.2,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,454.09,91,,,percent of total billed charges,91% of total billed charges,162.87,32.64,,,percent of total billed charges,32.64% of total billed charges,159.68,32,,,percent of total billed charges,32% of total billed charges,167.66,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,159.68,32,,,percent of total billed charges,32% of total billed charges,159.68,32,,,percent of total billed charges,32% of total billed charges,459.08,92,,,percent of total billed charges,92% of total billed charges,17.65,459.08,
T CELL ABSOLUTE CD4 COUNT,2000580,CDM,302,RC,86361,HCPCS,Outpatient,,,129,109.65,,104.75,81.2,,,percent of total billed charges,81.2% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,98.04,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,42.52,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,116.1,90,,,percent of total billed charges,90% of total billed charges,116.1,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,114.29,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,117.39,91,,,percent of total billed charges,91% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,43.34,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,118.68,92,,,percent of total billed charges,92% of total billed charges,17.65,118.68,
LIVER-KIDNEY MICROSOMAL ANTIBODY,2001346,CDM,302,RC,86376,HCPCS,Outpatient,,,109,92.65,,88.51,81.2,,,percent of total billed charges,81.2% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,82.84,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.93,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,98.1,90,,,percent of total billed charges,90% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,96.57,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,99.19,91,,,percent of total billed charges,91% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,36.62,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,100.28,92,,,percent of total billed charges,92% of total billed charges,13.55,100.28,
THYROID ANTIBODY,2000578,CDM,302,RC,86376,HCPCS,Outpatient,,,109,92.65,,88.51,81.2,,,percent of total billed charges,81.2% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,82.84,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.93,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,98.1,90,,,percent of total billed charges,90% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,96.57,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,99.19,91,,,percent of total billed charges,91% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,36.62,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,100.28,92,,,percent of total billed charges,92% of total billed charges,13.55,100.28,
THYROID PEROXIDASE,2001176,CDM,302,RC,86376,HCPCS,Outpatient,,,109,92.65,,88.51,81.2,,,percent of total billed charges,81.2% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,82.84,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.93,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,98.1,90,,,percent of total billed charges,90% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,96.57,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,99.19,91,,,percent of total billed charges,91% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,36.62,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,100.28,92,,,percent of total billed charges,92% of total billed charges,13.55,100.28,
THYROID PEROXIDASE ANTIBODIES,2000297,CDM,302,RC,86376,HCPCS,Outpatient,,,109,92.65,,88.51,81.2,,,percent of total billed charges,81.2% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,80.66,74,,,percent of total billed charges,74% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,73.03,67,,,percent of total billed charges,67% of total billed charges,77.39,71,,,percent of total billed charges,71% of total billed charges,82.84,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,35.93,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,98.1,90,,,percent of total billed charges,90% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,96.57,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,87.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,99.19,91,,,percent of total billed charges,91% of total billed charges,35.58,32.64,,,percent of total billed charges,32.64% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,36.62,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,34.88,32,,,percent of total billed charges,32% of total billed charges,34.88,32,,,percent of total billed charges,32% of total billed charges,100.28,92,,,percent of total billed charges,92% of total billed charges,13.55,100.28,
RA FACTOR (rheumatoid factor),2000409,CDM,302,RC,86431,HCPCS,Outpatient,,,40,34,,32.48,81.2,,,percent of total billed charges,81.2% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,30.4,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.18,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,36,90,,,percent of total billed charges,90% of total billed charges,36,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,35.44,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,36.4,91,,,percent of total billed charges,91% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,13.44,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,36.8,92,,,percent of total billed charges,92% of total billed charges,12.8,36.8,
QUANTIFERON TB GOLD PLUS,2001075,CDM,300,RC,86480,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,18.54,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,17.65,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,18.18,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,17.65,91.08,
RPR REFLEX CONFIRM,2001784,CDM,302,RC,86592,HCPCS,Outpatient,,,27,22.95,,21.92,81.2,,,percent of total billed charges,81.2% of total billed charges,8.81,32.64,,,percent of total billed charges,32.64% of total billed charges,19.98,74,,,percent of total billed charges,74% of total billed charges,19.98,74,,,percent of total billed charges,74% of total billed charges,8.64,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.64,32,,,percent of total billed charges,32% of total billed charges,19.17,71,,,percent of total billed charges,71% of total billed charges,19.17,71,,,percent of total billed charges,71% of total billed charges,18.09,67,,,percent of total billed charges,67% of total billed charges,18.09,67,,,percent of total billed charges,67% of total billed charges,19.17,71,,,percent of total billed charges,71% of total billed charges,20.52,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.9,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,23.92,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.64,32,,,percent of total billed charges,32% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,24.57,91,,,percent of total billed charges,91% of total billed charges,8.81,32.64,,,percent of total billed charges,32.64% of total billed charges,8.64,32,,,percent of total billed charges,32% of total billed charges,9.07,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.64,32,,,percent of total billed charges,32% of total billed charges,8.64,32,,,percent of total billed charges,32% of total billed charges,24.84,92,,,percent of total billed charges,92% of total billed charges,8.64,24.84,
VDRL CSF,2000402,CDM,302,RC,86592,HCPCS,Outpatient,,,27,22.95,,21.92,81.2,,,percent of total billed charges,81.2% of total billed charges,8.81,32.64,,,percent of total billed charges,32.64% of total billed charges,19.98,74,,,percent of total billed charges,74% of total billed charges,19.98,74,,,percent of total billed charges,74% of total billed charges,8.64,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.64,32,,,percent of total billed charges,32% of total billed charges,19.17,71,,,percent of total billed charges,71% of total billed charges,19.17,71,,,percent of total billed charges,71% of total billed charges,18.09,67,,,percent of total billed charges,67% of total billed charges,18.09,67,,,percent of total billed charges,67% of total billed charges,19.17,71,,,percent of total billed charges,71% of total billed charges,20.52,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.9,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,23.92,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.64,32,,,percent of total billed charges,32% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,24.57,91,,,percent of total billed charges,91% of total billed charges,8.81,32.64,,,percent of total billed charges,32.64% of total billed charges,8.64,32,,,percent of total billed charges,32% of total billed charges,9.07,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.64,32,,,percent of total billed charges,32% of total billed charges,8.64,32,,,percent of total billed charges,32% of total billed charges,24.84,92,,,percent of total billed charges,92% of total billed charges,8.64,24.84,
VDRL SERUM,2001174,CDM,302,RC,86592,HCPCS,Outpatient,,,27,22.95,,21.92,81.2,,,percent of total billed charges,81.2% of total billed charges,8.81,32.64,,,percent of total billed charges,32.64% of total billed charges,19.98,74,,,percent of total billed charges,74% of total billed charges,19.98,74,,,percent of total billed charges,74% of total billed charges,8.64,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.64,32,,,percent of total billed charges,32% of total billed charges,19.17,71,,,percent of total billed charges,71% of total billed charges,19.17,71,,,percent of total billed charges,71% of total billed charges,18.09,67,,,percent of total billed charges,67% of total billed charges,18.09,67,,,percent of total billed charges,67% of total billed charges,19.17,71,,,percent of total billed charges,71% of total billed charges,20.52,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.9,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,23.92,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.64,32,,,percent of total billed charges,32% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,21.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,24.57,91,,,percent of total billed charges,91% of total billed charges,8.81,32.64,,,percent of total billed charges,32.64% of total billed charges,8.64,32,,,percent of total billed charges,32% of total billed charges,9.07,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,8.64,32,,,percent of total billed charges,32% of total billed charges,8.64,32,,,percent of total billed charges,32% of total billed charges,24.84,92,,,percent of total billed charges,92% of total billed charges,8.64,24.84,
ASPERGILLUS ANTIBODY,2000665,CDM,302,RC,86606,HCPCS,Outpatient,,,40,34,,32.48,81.2,,,percent of total billed charges,81.2% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,30.4,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.18,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,36,90,,,percent of total billed charges,90% of total billed charges,36,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,35.44,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,36.4,91,,,percent of total billed charges,91% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,13.44,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,36.8,92,,,percent of total billed charges,92% of total billed charges,12.8,36.8,
CAT SCRATCH PANEL,2000671,CDM,302,RC,86611,HCPCS,Outpatient,,,46,39.1,,37.35,81.2,,,percent of total billed charges,81.2% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,34.96,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,15.16,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,41.4,90,,,percent of total billed charges,90% of total billed charges,41.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,40.76,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,41.86,91,,,percent of total billed charges,91% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,15.46,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,42.32,92,,,percent of total billed charges,92% of total billed charges,14.22,42.32,
BLASTOMYCES ANTIBODY,2000666,CDM,302,RC,86612,HCPCS,Outpatient,,,40,34,,32.48,81.2,,,percent of total billed charges,81.2% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,30.4,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.18,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,36,90,,,percent of total billed charges,90% of total billed charges,36,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,35.44,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,36.4,91,,,percent of total billed charges,91% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,13.44,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,36.8,92,,,percent of total billed charges,92% of total billed charges,12.8,36.8,
B PERTUSSIS IGA AB,2001225,CDM,302,RC,86615,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,14.22,205.16,
B PERTUSSIS IGG AB,2001188,CDM,302,RC,86615,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,14.22,205.16,
BORDETELLA PERTUSUS IGM,2000887,CDM,300,RC,86615,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,14.22,205.16,
LYMES DISEASE WESTERN BLOT SERUM,2000451,CDM,302,RC,86617,HCPCS,Outpatient,,,196,166.6,,159.15,81.2,,,percent of total billed charges,81.2% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,145.04,74,,,percent of total billed charges,74% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,131.32,67,,,percent of total billed charges,67% of total billed charges,139.16,71,,,percent of total billed charges,71% of total billed charges,148.96,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,64.6,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,176.4,90,,,percent of total billed charges,90% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,173.66,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,156.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,178.36,91,,,percent of total billed charges,91% of total billed charges,63.97,32.64,,,percent of total billed charges,32.64% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,65.86,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,62.72,32,,,percent of total billed charges,32% of total billed charges,62.72,32,,,percent of total billed charges,32% of total billed charges,180.32,92,,,percent of total billed charges,92% of total billed charges,14.22,180.32,
LYMES DISEASE SEROLOGY W/ REFLEX,2001649,CDM,302,RC,86618,HCPCS,Outpatient,,,41,34.85,,33.29,81.2,,,percent of total billed charges,81.2% of total billed charges,13.38,32.64,,,percent of total billed charges,32.64% of total billed charges,30.34,74,,,percent of total billed charges,74% of total billed charges,30.34,74,,,percent of total billed charges,74% of total billed charges,13.12,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.12,32,,,percent of total billed charges,32% of total billed charges,29.11,71,,,percent of total billed charges,71% of total billed charges,29.11,71,,,percent of total billed charges,71% of total billed charges,27.47,67,,,percent of total billed charges,67% of total billed charges,27.47,67,,,percent of total billed charges,67% of total billed charges,29.11,71,,,percent of total billed charges,71% of total billed charges,31.16,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.51,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,36.9,90,,,percent of total billed charges,90% of total billed charges,36.9,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,36.33,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.12,32,,,percent of total billed charges,32% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,37.31,91,,,percent of total billed charges,91% of total billed charges,13.38,32.64,,,percent of total billed charges,32.64% of total billed charges,13.12,32,,,percent of total billed charges,32% of total billed charges,13.78,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.12,32,,,percent of total billed charges,32% of total billed charges,13.12,32,,,percent of total billed charges,32% of total billed charges,37.72,92,,,percent of total billed charges,92% of total billed charges,13.12,37.72,
BRUCELLA  IgG ANTIBODY,2000217,CDM,306,RC,86622,HCPCS,Outpatient,,,76,64.6,,61.71,81.2,,,percent of total billed charges,81.2% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,57.76,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.05,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,67.34,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.16,91,,,percent of total billed charges,91% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,25.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,69.92,92,,,percent of total billed charges,92% of total billed charges,14.22,69.92,
BRUCELLA IgM ANTIBODY,2001338,CDM,306,RC,86622,HCPCS,Outpatient,,,76,64.6,,61.71,81.2,,,percent of total billed charges,81.2% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,57.76,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.05,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,67.34,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.16,91,,,percent of total billed charges,91% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,25.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,69.92,92,,,percent of total billed charges,92% of total billed charges,14.22,69.92,
CHLAMYDIA PNEUMONIAE IGA,2001753,CDM,302,RC,86631,HCPCS,Outpatient,,,117,99.45,,95,81.2,,,percent of total billed charges,81.2% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,88.92,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.56,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,105.3,90,,,percent of total billed charges,90% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,103.66,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,106.47,91,,,percent of total billed charges,91% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,39.31,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,107.64,92,,,percent of total billed charges,92% of total billed charges,14.22,107.64,
CHLAMYDIA PNEUMONIAE IgG,2000543,CDM,302,RC,86631,HCPCS,Outpatient,,,117,99.45,,95,81.2,,,percent of total billed charges,81.2% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,88.92,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.56,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,105.3,90,,,percent of total billed charges,90% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,103.66,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,106.47,91,,,percent of total billed charges,91% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,39.31,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,107.64,92,,,percent of total billed charges,92% of total billed charges,14.22,107.64,
CHLAMYDIA TRACHOMATIS IgG,2000334,CDM,302,RC,86631,HCPCS,Outpatient,,,117,99.45,,95,81.2,,,percent of total billed charges,81.2% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,88.92,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.56,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,105.3,90,,,percent of total billed charges,90% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,103.66,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,106.47,91,,,percent of total billed charges,91% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,39.31,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,107.64,92,,,percent of total billed charges,92% of total billed charges,14.22,107.64,
CHLAMYDIA PNEUMONIAE IGM,2001141,CDM,302,RC,86632,HCPCS,Outpatient,,,112,95.2,,90.94,81.2,,,percent of total billed charges,81.2% of total billed charges,36.56,32.64,,,percent of total billed charges,32.64% of total billed charges,82.88,74,,,percent of total billed charges,74% of total billed charges,82.88,74,,,percent of total billed charges,74% of total billed charges,35.84,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.84,32,,,percent of total billed charges,32% of total billed charges,79.52,71,,,percent of total billed charges,71% of total billed charges,79.52,71,,,percent of total billed charges,71% of total billed charges,75.04,67,,,percent of total billed charges,67% of total billed charges,75.04,67,,,percent of total billed charges,67% of total billed charges,79.52,71,,,percent of total billed charges,71% of total billed charges,85.12,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,36.92,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,100.8,90,,,percent of total billed charges,90% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,99.23,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.84,32,,,percent of total billed charges,32% of total billed charges,89.6,80,,,percent of total billed charges,80% of total billed charges,89.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,101.92,91,,,percent of total billed charges,91% of total billed charges,36.56,32.64,,,percent of total billed charges,32.64% of total billed charges,35.84,32,,,percent of total billed charges,32% of total billed charges,37.63,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,35.84,32,,,percent of total billed charges,32% of total billed charges,35.84,32,,,percent of total billed charges,32% of total billed charges,103.04,92,,,percent of total billed charges,92% of total billed charges,14.22,103.04,
COCCIDIOIDES ANTIBODY,2000667,CDM,302,RC,86635,HCPCS,Outpatient,,,40,34,,32.48,81.2,,,percent of total billed charges,81.2% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,30.4,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.18,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,36,90,,,percent of total billed charges,90% of total billed charges,36,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,35.44,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,36.4,91,,,percent of total billed charges,91% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,13.44,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,36.8,92,,,percent of total billed charges,92% of total billed charges,12.8,36.8,
CYTOMEGALOVIRUS CMV,2000170,CDM,302,RC,86644,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,14.22,79.12,
CMV IGM,2000841,CDM,300,RC,86645,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,14.22,41.4,
DIPTHERIA ANTIBODY,2000533,CDM,302,RC,86648,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,14.22,91.08,
ENCEPHALITIS CALIFORNIA/LACROSS,2000850,CDM,300,RC,86651,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,14.22,70.84,
ENCEPHALITIS EASTERN EQUINE IgG/IgM,2000851,CDM,300,RC,86652,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,14.22,70.84,
ENCEPHALITIS ST LOUIS IgG/IgM,2000852,CDM,300,RC,86653,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,14.22,70.84,
ENCEPHALITIS WESTERN EQUINE IgG/IgM,2000625,CDM,300,RC,86654,HCPCS,Outpatient,,,139,118.15,,112.87,81.2,,,percent of total billed charges,81.2% of total billed charges,45.37,32.64,,,percent of total billed charges,32.64% of total billed charges,102.86,74,,,percent of total billed charges,74% of total billed charges,102.86,74,,,percent of total billed charges,74% of total billed charges,44.48,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,44.48,32,,,percent of total billed charges,32% of total billed charges,98.69,71,,,percent of total billed charges,71% of total billed charges,98.69,71,,,percent of total billed charges,71% of total billed charges,93.13,67,,,percent of total billed charges,67% of total billed charges,93.13,67,,,percent of total billed charges,67% of total billed charges,98.69,71,,,percent of total billed charges,71% of total billed charges,105.64,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,45.81,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,125.1,90,,,percent of total billed charges,90% of total billed charges,125.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,123.15,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,44.48,32,,,percent of total billed charges,32% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,126.49,91,,,percent of total billed charges,91% of total billed charges,45.37,32.64,,,percent of total billed charges,32.64% of total billed charges,44.48,32,,,percent of total billed charges,32% of total billed charges,46.7,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,44.48,32,,,percent of total billed charges,32% of total billed charges,44.48,32,,,percent of total billed charges,32% of total billed charges,127.88,92,,,percent of total billed charges,92% of total billed charges,14.22,127.88,
EPSTEIN BARR EA IGG,2001787,CDM,302,RC,86664,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,14.22,64.4,
EPSTEIN-VARR VIRUS NUCLEAR ANTIGEN ANTIB,2001507,CDM,300,RC,86664,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,14.22,64.4,
EPSTEIN BARR VCA IgG,2000476,CDM,302,RC,86665,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,14.22,74.52,
EPSTEIN BARR VCA IgM,2000477,CDM,302,RC,86665,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,14.22,74.52,
FUNGAL ANTIBODIES,2000166,CDM,306,RC,86671,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
HELICOBACTER IGA ONLY,2001093,CDM,302,RC,86677,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,14.22,95.68,
HELICOBACTOR IGG ONLY,2000370,CDM,302,RC,86677,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,14.22,95.68,
"HELICOBACTOR, IGM ONLY",2001094,CDM,302,RC,86677,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,14.22,95.68,
HIV 1 IMMUNOASSAY,2000880,CDM,300,RC,86689,HCPCS,Outpatient,,,173,147.05,,140.48,81.2,,,percent of total billed charges,81.2% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,131.48,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,57.02,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,155.7,90,,,percent of total billed charges,90% of total billed charges,155.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,153.28,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,157.43,91,,,percent of total billed charges,91% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,58.13,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,159.16,92,,,percent of total billed charges,92% of total billed charges,14.22,159.16,
HERPES I IgG,2000441,CDM,302,RC,86695,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
HERPES II IgG,2000726,CDM,300,RC,86696,HCPCS,Outpatient,,,72,61.2,,58.46,81.2,,,percent of total billed charges,81.2% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,54.72,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.73,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,63.79,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,65.52,91,,,percent of total billed charges,91% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,24.19,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,66.24,92,,,percent of total billed charges,92% of total billed charges,14.22,66.24,
HERPES SIMPLEX VIRUS TYPE 2 IGG SPECIFIC,2001208,CDM,302,RC,86696,HCPCS,Outpatient,,,72,61.2,,58.46,81.2,,,percent of total billed charges,81.2% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,54.72,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.73,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,63.79,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,65.52,91,,,percent of total billed charges,91% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,24.19,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,66.24,92,,,percent of total billed charges,92% of total billed charges,14.22,66.24,
HISTOPLASMA ANTIBODY,2000668,CDM,302,RC,86698,HCPCS,Outpatient,,,116,98.6,,94.19,81.2,,,percent of total billed charges,81.2% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,88.16,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.23,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,104.4,90,,,percent of total billed charges,90% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,102.78,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,105.56,91,,,percent of total billed charges,91% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,38.98,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,106.72,92,,,percent of total billed charges,92% of total billed charges,14.22,106.72,
HISTOPLASMA SERUM ANTIGEN,2001337,CDM,306,RC,86698,HCPCS,Outpatient,,,116,98.6,,94.19,81.2,,,percent of total billed charges,81.2% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,88.16,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.23,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,104.4,90,,,percent of total billed charges,90% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,102.78,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,105.56,91,,,percent of total billed charges,91% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,38.98,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,106.72,92,,,percent of total billed charges,92% of total billed charges,14.22,106.72,
"HEPATITIS B CORE, TOTAL ANTIBODY",2000328,CDM,302,RC,86704,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,14.22,85.56,
"HEPATITIS B CORE, IgM ANTIBODY",2000075,CDM,302,RC,86705,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,14.22,74.52,
HEPATITIS B SURFACE AB QUAL,2001775,CDM,300,RC,86706,HCPCS,Outpatient,,,51,43.35,,41.41,81.2,,,percent of total billed charges,81.2% of total billed charges,16.65,32.64,,,percent of total billed charges,32.64% of total billed charges,37.74,74,,,percent of total billed charges,74% of total billed charges,37.74,74,,,percent of total billed charges,74% of total billed charges,16.32,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.32,32,,,percent of total billed charges,32% of total billed charges,36.21,71,,,percent of total billed charges,71% of total billed charges,36.21,71,,,percent of total billed charges,71% of total billed charges,34.17,67,,,percent of total billed charges,67% of total billed charges,34.17,67,,,percent of total billed charges,67% of total billed charges,36.21,71,,,percent of total billed charges,71% of total billed charges,38.76,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.81,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,45.9,90,,,percent of total billed charges,90% of total billed charges,45.9,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,45.19,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.32,32,,,percent of total billed charges,32% of total billed charges,40.8,80,,,percent of total billed charges,80% of total billed charges,40.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,46.41,91,,,percent of total billed charges,91% of total billed charges,16.65,32.64,,,percent of total billed charges,32.64% of total billed charges,16.32,32,,,percent of total billed charges,32% of total billed charges,17.14,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.32,32,,,percent of total billed charges,32% of total billed charges,16.32,32,,,percent of total billed charges,32% of total billed charges,46.92,92,,,percent of total billed charges,92% of total billed charges,14.22,46.92,
HEPATITIS B SURFACE ANTIBODY,2000076,CDM,302,RC,86706,HCPCS,Outpatient,,,52,44.2,,42.22,81.2,,,percent of total billed charges,81.2% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,39.52,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.14,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,46.8,90,,,percent of total billed charges,90% of total billed charges,46.8,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,46.07,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,47.32,91,,,percent of total billed charges,91% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,17.47,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,47.84,92,,,percent of total billed charges,92% of total billed charges,14.22,47.84,
HEPATITIS BE ANTIBODY,2000078,CDM,302,RC,86707,HCPCS,Outpatient,,,49,41.65,,39.79,81.2,,,percent of total billed charges,81.2% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,36.26,74,,,percent of total billed charges,74% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,32.83,67,,,percent of total billed charges,67% of total billed charges,34.79,71,,,percent of total billed charges,71% of total billed charges,37.24,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.15,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,44.1,90,,,percent of total billed charges,90% of total billed charges,44.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,43.41,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,39.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,44.59,91,,,percent of total billed charges,91% of total billed charges,15.99,32.64,,,percent of total billed charges,32.64% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,16.46,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,15.68,32,,,percent of total billed charges,32% of total billed charges,15.68,32,,,percent of total billed charges,32% of total billed charges,45.08,92,,,percent of total billed charges,92% of total billed charges,14.22,45.08,
HEPATITIS A ANTIBODY,2000079,CDM,302,RC,86708,HCPCS,Outpatient,,,161,136.85,,130.73,81.2,,,percent of total billed charges,81.2% of total billed charges,52.55,32.64,,,percent of total billed charges,32.64% of total billed charges,119.14,74,,,percent of total billed charges,74% of total billed charges,119.14,74,,,percent of total billed charges,74% of total billed charges,51.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,51.52,32,,,percent of total billed charges,32% of total billed charges,114.31,71,,,percent of total billed charges,71% of total billed charges,114.31,71,,,percent of total billed charges,71% of total billed charges,107.87,67,,,percent of total billed charges,67% of total billed charges,107.87,67,,,percent of total billed charges,67% of total billed charges,114.31,71,,,percent of total billed charges,71% of total billed charges,122.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,53.07,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,144.9,90,,,percent of total billed charges,90% of total billed charges,144.9,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,142.65,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,51.52,32,,,percent of total billed charges,32% of total billed charges,128.8,80,,,percent of total billed charges,80% of total billed charges,128.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,146.51,91,,,percent of total billed charges,91% of total billed charges,52.55,32.64,,,percent of total billed charges,32.64% of total billed charges,51.52,32,,,percent of total billed charges,32% of total billed charges,54.1,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,51.52,32,,,percent of total billed charges,32% of total billed charges,51.52,32,,,percent of total billed charges,32% of total billed charges,148.12,92,,,percent of total billed charges,92% of total billed charges,14.22,148.12,
HEPATITIS A ANTIBODY IGM,2000080,CDM,302,RC,86709,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,14.22,74.52,
MUMPS IgG IMMUNE STATUS,2000343,CDM,302,RC,86735,HCPCS,Outpatient,,,94,79.9,,76.33,81.2,,,percent of total billed charges,81.2% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,71.44,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.98,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,84.6,90,,,percent of total billed charges,90% of total billed charges,84.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,83.28,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,85.54,91,,,percent of total billed charges,91% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,31.58,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,86.48,92,,,percent of total billed charges,92% of total billed charges,14.22,86.48,
MUMPS IgG/IgM ANTIBODIES,2000200,CDM,302,RC,86735,HCPCS,Outpatient,,,94,79.9,,76.33,81.2,,,percent of total billed charges,81.2% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,69.56,74,,,percent of total billed charges,74% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,62.98,67,,,percent of total billed charges,67% of total billed charges,66.74,71,,,percent of total billed charges,71% of total billed charges,71.44,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.98,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,84.6,90,,,percent of total billed charges,90% of total billed charges,84.6,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,83.28,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,75.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,85.54,91,,,percent of total billed charges,91% of total billed charges,30.68,32.64,,,percent of total billed charges,32.64% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,31.58,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,30.08,32,,,percent of total billed charges,32% of total billed charges,30.08,32,,,percent of total billed charges,32% of total billed charges,86.48,92,,,percent of total billed charges,92% of total billed charges,14.22,86.48,
MYCOPLASM PNEUMONIA IgG,2000228,CDM,302,RC,86738,HCPCS,Outpatient,,,52,44.2,,42.22,81.2,,,percent of total billed charges,81.2% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,39.52,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.14,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,46.8,90,,,percent of total billed charges,90% of total billed charges,46.8,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,46.07,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,47.32,91,,,percent of total billed charges,91% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,17.47,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,47.84,92,,,percent of total billed charges,92% of total billed charges,14.22,47.84,
MYCOPLASMA  PNEUMOMNIAE IGM,2000511,CDM,302,RC,86738,HCPCS,Outpatient,,,52,44.2,,42.22,81.2,,,percent of total billed charges,81.2% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,39.52,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.14,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,46.8,90,,,percent of total billed charges,90% of total billed charges,46.8,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,46.07,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,47.32,91,,,percent of total billed charges,91% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,17.47,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,47.84,92,,,percent of total billed charges,92% of total billed charges,14.22,47.84,
RICKETTSI ANTIBODIES,2000921,CDM,300,RC,86757,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,14.22,79.12,
ROCKY MOUNTAIN FEVER IgG,2000124,CDM,302,RC,86757,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,14.22,79.12,
ROCKY MOUNTAIN FEVER IGM,2000349,CDM,302,RC,86757,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,14.22,79.12,
RUBELLA,2000126,CDM,302,RC,86762,HCPCS,Outpatient,,,83,70.55,,67.4,81.2,,,percent of total billed charges,81.2% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,63.08,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.36,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,74.7,90,,,percent of total billed charges,90% of total billed charges,74.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,73.54,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,75.53,91,,,percent of total billed charges,91% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,27.89,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,76.36,92,,,percent of total billed charges,92% of total billed charges,14.22,76.36,
RUBEOLA IgG,2000292,CDM,302,RC,86765,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,14.22,74.52,
RUBEOLA IGM,2001145,CDM,302,RC,86765,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,14.22,74.52,
SARS-COV-2 ANTIBODY IGG,2001815,CDM,300,RC,86769,HCPCS,Outpatient,,,432,367.2,,350.78,81.2,,,percent of total billed charges,81.2% of total billed charges,141,32.64,,,percent of total billed charges,32.64% of total billed charges,319.68,74,,,percent of total billed charges,74% of total billed charges,319.68,74,,,percent of total billed charges,74% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,289.44,67,,,percent of total billed charges,67% of total billed charges,289.44,67,,,percent of total billed charges,67% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,328.32,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,142.39,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,388.8,90,,,percent of total billed charges,90% of total billed charges,388.8,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,382.75,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,345.6,80,,,percent of total billed charges,80% of total billed charges,345.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,393.12,91,,,percent of total billed charges,91% of total billed charges,141,32.64,,,percent of total billed charges,32.64% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,145.15,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,397.44,92,,,percent of total billed charges,92% of total billed charges,14.22,397.44,
SARS-COV-2 ANTIBODY IGM,2001813,CDM,300,RC,86769,HCPCS,Outpatient,,,432,367.2,,350.78,81.2,,,percent of total billed charges,81.2% of total billed charges,141,32.64,,,percent of total billed charges,32.64% of total billed charges,319.68,74,,,percent of total billed charges,74% of total billed charges,319.68,74,,,percent of total billed charges,74% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,289.44,67,,,percent of total billed charges,67% of total billed charges,289.44,67,,,percent of total billed charges,67% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,328.32,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,142.39,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,388.8,90,,,percent of total billed charges,90% of total billed charges,388.8,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,382.75,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,345.6,80,,,percent of total billed charges,80% of total billed charges,345.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,393.12,91,,,percent of total billed charges,91% of total billed charges,141,32.64,,,percent of total billed charges,32.64% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,145.15,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,397.44,92,,,percent of total billed charges,92% of total billed charges,14.22,397.44,
TETANUS ANTIBODY,2000532,CDM,302,RC,86774,HCPCS,Outpatient,,,66,56.1,,53.59,81.2,,,percent of total billed charges,81.2% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,50.16,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.75,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,58.48,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,60.06,91,,,percent of total billed charges,91% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,22.18,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,60.72,92,,,percent of total billed charges,92% of total billed charges,14.22,60.72,
TOXOPLASMA IGG,2000232,CDM,302,RC,86777,HCPCS,Outpatient,,,119,101.15,,96.63,81.2,,,percent of total billed charges,81.2% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,90.44,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,39.22,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,105.43,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,108.29,91,,,percent of total billed charges,91% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,39.98,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,109.48,92,,,percent of total billed charges,92% of total billed charges,14.22,109.48,
TOXOPLASMA IGM,2000233,CDM,302,RC,86778,HCPCS,Outpatient,,,119,101.15,,96.63,81.2,,,percent of total billed charges,81.2% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,90.44,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,39.22,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,105.43,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,108.29,91,,,percent of total billed charges,91% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,39.98,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,109.48,92,,,percent of total billed charges,92% of total billed charges,14.22,109.48,
TREPONEMA PALLIDUM ANTIBODIES,2001643,CDM,302,RC,86780,HCPCS,Outpatient,,,56,47.6,,45.47,81.2,,,percent of total billed charges,81.2% of total billed charges,18.28,32.64,,,percent of total billed charges,32.64% of total billed charges,41.44,74,,,percent of total billed charges,74% of total billed charges,41.44,74,,,percent of total billed charges,74% of total billed charges,17.92,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.92,32,,,percent of total billed charges,32% of total billed charges,39.76,71,,,percent of total billed charges,71% of total billed charges,39.76,71,,,percent of total billed charges,71% of total billed charges,37.52,67,,,percent of total billed charges,67% of total billed charges,37.52,67,,,percent of total billed charges,67% of total billed charges,39.76,71,,,percent of total billed charges,71% of total billed charges,42.56,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,18.46,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,50.4,90,,,percent of total billed charges,90% of total billed charges,50.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,49.62,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.92,32,,,percent of total billed charges,32% of total billed charges,44.8,80,,,percent of total billed charges,80% of total billed charges,44.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,50.96,91,,,percent of total billed charges,91% of total billed charges,18.28,32.64,,,percent of total billed charges,32.64% of total billed charges,17.92,32,,,percent of total billed charges,32% of total billed charges,18.82,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,17.92,32,,,percent of total billed charges,32% of total billed charges,17.92,32,,,percent of total billed charges,32% of total billed charges,51.52,92,,,percent of total billed charges,92% of total billed charges,14.22,51.52,
VARICELLA ZOSTER IGG IMMUNE,2000234,CDM,302,RC,86787,HCPCS,Outpatient,,,63,53.55,,51.16,81.2,,,percent of total billed charges,81.2% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,47.88,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.76,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,55.82,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,57.33,91,,,percent of total billed charges,91% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,21.17,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,57.96,92,,,percent of total billed charges,92% of total billed charges,14.22,57.96,
VARICELLA ZOSTER IGM,2000235,CDM,302,RC,86787,HCPCS,Outpatient,,,63,53.55,,51.16,81.2,,,percent of total billed charges,81.2% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,46.62,74,,,percent of total billed charges,74% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,42.21,67,,,percent of total billed charges,67% of total billed charges,44.73,71,,,percent of total billed charges,71% of total billed charges,47.88,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.76,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,55.82,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,50.4,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,57.33,91,,,percent of total billed charges,91% of total billed charges,20.56,32.64,,,percent of total billed charges,32.64% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,21.17,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,20.16,32,,,percent of total billed charges,32% of total billed charges,20.16,32,,,percent of total billed charges,32% of total billed charges,57.96,92,,,percent of total billed charges,92% of total billed charges,14.22,57.96,
WEST NILE IGM SERUM,2000889,CDM,300,RC,86788,HCPCS,Outpatient,,,67,56.95,,54.4,81.2,,,percent of total billed charges,81.2% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,50.92,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,22.08,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,60.3,90,,,percent of total billed charges,90% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,59.36,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,60.97,91,,,percent of total billed charges,91% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,22.51,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,61.64,92,,,percent of total billed charges,92% of total billed charges,14.22,61.64,
"WEST NILE IGG,IGM SERUM",2000888,CDM,300,RC,86789,HCPCS,Outpatient,,,67,56.95,,54.4,81.2,,,percent of total billed charges,81.2% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,50.92,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,22.08,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,60.3,90,,,percent of total billed charges,90% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,59.36,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,60.97,91,,,percent of total billed charges,91% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,22.51,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,61.64,92,,,percent of total billed charges,92% of total billed charges,14.22,61.64,
HEPATITIS E ANTIBODY,2000453,CDM,302,RC,86790,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,14.22,41.4,
TGAB + THYROGLOBULIN,2001475,CDM,302,RC,86800,HCPCS,Outpatient,,,174,147.9,,141.29,81.2,,,percent of total billed charges,81.2% of total billed charges,56.79,32.64,,,percent of total billed charges,32.64% of total billed charges,128.76,74,,,percent of total billed charges,74% of total billed charges,128.76,74,,,percent of total billed charges,74% of total billed charges,55.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,55.68,32,,,percent of total billed charges,32% of total billed charges,123.54,71,,,percent of total billed charges,71% of total billed charges,123.54,71,,,percent of total billed charges,71% of total billed charges,116.58,67,,,percent of total billed charges,67% of total billed charges,116.58,67,,,percent of total billed charges,67% of total billed charges,123.54,71,,,percent of total billed charges,71% of total billed charges,132.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,57.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,156.6,90,,,percent of total billed charges,90% of total billed charges,156.6,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,154.16,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,55.68,32,,,percent of total billed charges,32% of total billed charges,139.2,80,,,percent of total billed charges,80% of total billed charges,139.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,158.34,91,,,percent of total billed charges,91% of total billed charges,56.79,32.64,,,percent of total billed charges,32.64% of total billed charges,55.68,32,,,percent of total billed charges,32% of total billed charges,58.46,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,55.68,32,,,percent of total billed charges,32% of total billed charges,55.68,32,,,percent of total billed charges,32% of total billed charges,160.08,92,,,percent of total billed charges,92% of total billed charges,13.55,160.08,
THYROGLOBULIN ANTIBODY,2000278,CDM,301,RC,86800,HCPCS,Outpatient,,,174,147.9,,141.29,81.2,,,percent of total billed charges,81.2% of total billed charges,56.79,32.64,,,percent of total billed charges,32.64% of total billed charges,128.76,74,,,percent of total billed charges,74% of total billed charges,128.76,74,,,percent of total billed charges,74% of total billed charges,55.68,32,,,percent of total billed charges,32% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,55.68,32,,,percent of total billed charges,32% of total billed charges,123.54,71,,,percent of total billed charges,71% of total billed charges,123.54,71,,,percent of total billed charges,71% of total billed charges,116.58,67,,,percent of total billed charges,67% of total billed charges,116.58,67,,,percent of total billed charges,67% of total billed charges,123.54,71,,,percent of total billed charges,71% of total billed charges,132.24,76,,,percent of total billed charges,76% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,57.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.23,105,,,Fee Schedule,pays based on EAPG rates,156.6,90,,,percent of total billed charges,90% of total billed charges,156.6,90,,,percent of total billed charges,90% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,154.16,88.6,,,percent of total billed charges,88.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,55.68,32,,,percent of total billed charges,32% of total billed charges,139.2,80,,,percent of total billed charges,80% of total billed charges,139.2,80,,,percent of total billed charges,80% of total billed charges,13.55,100,,,Fee Schedule,pays based on EAPG rates,158.34,91,,,percent of total billed charges,91% of total billed charges,56.79,32.64,,,percent of total billed charges,32.64% of total billed charges,55.68,32,,,percent of total billed charges,32% of total billed charges,58.46,33.6,,,percent of total billed charges,33.6% of total billed charges,13.96,103,,,Fee Schedule,pays based on EAPG rates,55.68,32,,,percent of total billed charges,32% of total billed charges,55.68,32,,,percent of total billed charges,32% of total billed charges,160.08,92,,,percent of total billed charges,92% of total billed charges,13.55,160.08,
HEPATITIS C AMPLIFICATION,2000571,CDM,301,RC,86803,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
HEPATITIS C ANTIBODY,2000247,CDM,302,RC,86803,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
HEPATITIS C ANTIBODY WITH REFLEX TO VERI,2001138,CDM,302,RC,86803,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,14.22,72.68,
BB ANTIBODY SCREEN,2000030,CDM,300,RC,86850,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,43.7,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,32.96,94.76,
BB COOMBS DIRECT,2000029,CDM,302,RC,86880,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,43.7,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,27.52,79.12,
COOMBS DIRECT (LAB CORP),2001307,CDM,302,RC,86880,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,43.7,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,27.52,79.12,
BB TYPE,2000070,CDM,300,RC,86900,HCPCS,Outpatient,,,83,70.55,,67.4,81.2,,,percent of total billed charges,81.2% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,61.42,74,,,percent of total billed charges,74% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,55.61,67,,,percent of total billed charges,67% of total billed charges,58.93,71,,,percent of total billed charges,71% of total billed charges,63.08,76,,,percent of total billed charges,76% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,27.36,32.96,,,percent of total billed charges,32.96% of total billed charges,43.7,105,,,Fee Schedule,pays based on EAPG rates,74.7,90,,,percent of total billed charges,90% of total billed charges,74.7,90,,,percent of total billed charges,90% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,73.54,88.6,,,percent of total billed charges,88.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,66.4,80,,,percent of total billed charges,80% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,75.53,91,,,percent of total billed charges,91% of total billed charges,27.09,32.64,,,percent of total billed charges,32.64% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,27.89,33.6,,,percent of total billed charges,33.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,26.56,32,,,percent of total billed charges,32% of total billed charges,26.56,32,,,percent of total billed charges,32% of total billed charges,76.36,92,,,percent of total billed charges,92% of total billed charges,26.56,76.36,
BB RH FACTOR,2000348,CDM,300,RC,86901,HCPCS,Outpatient,,,36,30.6,,29.23,81.2,,,percent of total billed charges,81.2% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,17.67,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,27.36,76,,,percent of total billed charges,76% of total billed charges,17.67,103,,,Fee Schedule,pays based on EAPG rates,11.87,32.96,,,percent of total billed charges,32.96% of total billed charges,18.01,105,,,Fee Schedule,pays based on EAPG rates,32.4,90,,,percent of total billed charges,90% of total billed charges,32.4,90,,,percent of total billed charges,90% of total billed charges,17.15,100,,,Fee Schedule,pays based on EAPG rates,31.9,88.6,,,percent of total billed charges,88.6% of total billed charges,17.67,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,17.15,100,,,Fee Schedule,pays based on EAPG rates,32.76,91,,,percent of total billed charges,91% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,12.1,33.6,,,percent of total billed charges,33.6% of total billed charges,17.67,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,33.12,92,,,percent of total billed charges,92% of total billed charges,11.52,33.12,
BB COMPATIBILITY IS,2001302,CDM,309,RC,86920,HCPCS,Outpatient,,,38,32.3,,30.86,81.2,,,percent of total billed charges,81.2% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,28.12,74,,,percent of total billed charges,74% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,25.46,67,,,percent of total billed charges,67% of total billed charges,26.98,71,,,percent of total billed charges,71% of total billed charges,28.88,76,,,percent of total billed charges,76% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,12.52,32.96,,,percent of total billed charges,32.96% of total billed charges,43.7,105,,,Fee Schedule,pays based on EAPG rates,34.2,90,,,percent of total billed charges,90% of total billed charges,34.2,90,,,percent of total billed charges,90% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,33.67,88.6,,,percent of total billed charges,88.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,30.4,80,,,percent of total billed charges,80% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,34.58,91,,,percent of total billed charges,91% of total billed charges,12.4,32.64,,,percent of total billed charges,32.64% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,12.77,33.6,,,percent of total billed charges,33.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,12.16,32,,,percent of total billed charges,32% of total billed charges,12.16,32,,,percent of total billed charges,32% of total billed charges,34.96,92,,,percent of total billed charges,92% of total billed charges,12.16,43.7,
BB CROSSMATCH,2000038,CDM,309,RC,86922,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,43.7,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,41.62,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,42.87,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,32.96,94.76,
BB PLASMA FF THAWINGEACH,2000492,CDM,302,RC,86927,HCPCS,Outpatient,,,31,26.35,,25.17,81.2,,,percent of total billed charges,81.2% of total billed charges,10.12,32.64,,,percent of total billed charges,32.64% of total billed charges,22.94,74,,,percent of total billed charges,74% of total billed charges,22.94,74,,,percent of total billed charges,74% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,40.7,103,,,Fee Schedule,pays based on EAPG rates,9.92,32,,,percent of total billed charges,32% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,20.77,67,,,percent of total billed charges,67% of total billed charges,20.77,67,,,percent of total billed charges,67% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,23.56,76,,,percent of total billed charges,76% of total billed charges,40.7,103,,,Fee Schedule,pays based on EAPG rates,10.22,32.96,,,percent of total billed charges,32.96% of total billed charges,41.49,105,,,Fee Schedule,pays based on EAPG rates,27.9,90,,,percent of total billed charges,90% of total billed charges,27.9,90,,,percent of total billed charges,90% of total billed charges,39.52,100,,,Fee Schedule,pays based on EAPG rates,27.47,88.6,,,percent of total billed charges,88.6% of total billed charges,40.7,103,,,Fee Schedule,pays based on EAPG rates,9.92,32,,,percent of total billed charges,32% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,39.52,100,,,Fee Schedule,pays based on EAPG rates,28.21,91,,,percent of total billed charges,91% of total billed charges,10.12,32.64,,,percent of total billed charges,32.64% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,10.42,33.6,,,percent of total billed charges,33.6% of total billed charges,40.7,103,,,Fee Schedule,pays based on EAPG rates,9.92,32,,,percent of total billed charges,32% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,28.52,92,,,percent of total billed charges,92% of total billed charges,9.92,41.49,
CONCENTRATION INF. AGENT,2000974,CDM,300,RC,87015,HCPCS,Outpatient,,,13,11.05,,10.56,81.2,,,percent of total billed charges,81.2% of total billed charges,4.24,32.64,,,percent of total billed charges,32.64% of total billed charges,9.62,74,,,percent of total billed charges,74% of total billed charges,9.62,74,,,percent of total billed charges,74% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,4.16,32,,,percent of total billed charges,32% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,8.71,67,,,percent of total billed charges,67% of total billed charges,8.71,67,,,percent of total billed charges,67% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,9.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,4.28,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,11.7,90,,,percent of total billed charges,90% of total billed charges,11.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,11.52,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,4.16,32,,,percent of total billed charges,32% of total billed charges,10.4,80,,,percent of total billed charges,80% of total billed charges,10.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,11.83,91,,,percent of total billed charges,91% of total billed charges,4.24,32.64,,,percent of total billed charges,32.64% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,4.37,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,4.16,32,,,percent of total billed charges,32% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,11.96,92,,,percent of total billed charges,92% of total billed charges,4.16,11.96,
AEROBIC BLOOD CULTURE,2001802,CDM,300,RC,87040,HCPCS,Outpatient,,,116,98.6,,94.19,81.2,,,percent of total billed charges,81.2% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,88.16,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,38.23,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,104.4,90,,,percent of total billed charges,90% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,102.78,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,105.56,91,,,percent of total billed charges,91% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,38.98,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,106.72,92,,,percent of total billed charges,92% of total billed charges,10.25,106.72,
AEROBIC PEDIATRIC BLOOD CULTURE,2001808,CDM,300,RC,87040,HCPCS,Outpatient,,,116,98.6,,94.19,81.2,,,percent of total billed charges,81.2% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,88.16,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,38.23,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,104.4,90,,,percent of total billed charges,90% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,102.78,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,105.56,91,,,percent of total billed charges,91% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,38.98,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,106.72,92,,,percent of total billed charges,92% of total billed charges,10.25,106.72,
CULTURE BLOOD,2000043,CDM,300,RC,87040,HCPCS,Outpatient,,,116,98.6,,94.19,81.2,,,percent of total billed charges,81.2% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,85.84,74,,,percent of total billed charges,74% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,77.72,67,,,percent of total billed charges,67% of total billed charges,82.36,71,,,percent of total billed charges,71% of total billed charges,88.16,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,38.23,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,104.4,90,,,percent of total billed charges,90% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,102.78,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,92.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,105.56,91,,,percent of total billed charges,91% of total billed charges,37.86,32.64,,,percent of total billed charges,32.64% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,38.98,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.12,32,,,percent of total billed charges,32% of total billed charges,37.12,32,,,percent of total billed charges,32% of total billed charges,106.72,92,,,percent of total billed charges,92% of total billed charges,10.25,106.72,
STOOL CULTURE,2000357,CDM,306,RC,87045,HCPCS,Outpatient,,,162,137.7,,131.54,81.2,,,percent of total billed charges,81.2% of total billed charges,52.88,32.64,,,percent of total billed charges,32.64% of total billed charges,119.88,74,,,percent of total billed charges,74% of total billed charges,119.88,74,,,percent of total billed charges,74% of total billed charges,51.84,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,51.84,32,,,percent of total billed charges,32% of total billed charges,115.02,71,,,percent of total billed charges,71% of total billed charges,115.02,71,,,percent of total billed charges,71% of total billed charges,108.54,67,,,percent of total billed charges,67% of total billed charges,108.54,67,,,percent of total billed charges,67% of total billed charges,115.02,71,,,percent of total billed charges,71% of total billed charges,123.12,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,53.4,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,145.8,90,,,percent of total billed charges,90% of total billed charges,145.8,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,143.53,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,51.84,32,,,percent of total billed charges,32% of total billed charges,129.6,80,,,percent of total billed charges,80% of total billed charges,129.6,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,147.42,91,,,percent of total billed charges,91% of total billed charges,52.88,32.64,,,percent of total billed charges,32.64% of total billed charges,51.84,32,,,percent of total billed charges,32% of total billed charges,54.43,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,51.84,32,,,percent of total billed charges,32% of total billed charges,51.84,32,,,percent of total billed charges,32% of total billed charges,149.04,92,,,percent of total billed charges,92% of total billed charges,10.25,149.04,
YERSINA,2000731,CDM,306,RC,87046,HCPCS,Outpatient,,,46,39.1,,37.35,81.2,,,percent of total billed charges,81.2% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,34.04,74,,,percent of total billed charges,74% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,30.82,67,,,percent of total billed charges,67% of total billed charges,32.66,71,,,percent of total billed charges,71% of total billed charges,34.96,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,15.16,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,41.4,90,,,percent of total billed charges,90% of total billed charges,41.4,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,40.76,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,36.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,41.86,91,,,percent of total billed charges,91% of total billed charges,15.01,32.64,,,percent of total billed charges,32.64% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,15.46,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,14.72,32,,,percent of total billed charges,32% of total billed charges,14.72,32,,,percent of total billed charges,32% of total billed charges,42.32,92,,,percent of total billed charges,92% of total billed charges,10.25,42.32,
AEROBIC ROUTINE WITHOUT GRAM STAIN,2001106,CDM,306,RC,87070,HCPCS,Outpatient,,,163,138.55,,132.36,81.2,,,percent of total billed charges,81.2% of total billed charges,53.2,32.64,,,percent of total billed charges,32.64% of total billed charges,120.62,74,,,percent of total billed charges,74% of total billed charges,120.62,74,,,percent of total billed charges,74% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,109.21,67,,,percent of total billed charges,67% of total billed charges,109.21,67,,,percent of total billed charges,67% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,123.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,53.72,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,146.7,90,,,percent of total billed charges,90% of total billed charges,146.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,144.42,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,130.4,80,,,percent of total billed charges,80% of total billed charges,130.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,148.33,91,,,percent of total billed charges,91% of total billed charges,53.2,32.64,,,percent of total billed charges,32.64% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,54.77,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,149.96,92,,,percent of total billed charges,92% of total billed charges,10.25,149.96,
CSF/ BF  CULTURE,2000040,CDM,306,RC,87070,HCPCS,Outpatient,,,163,138.55,,132.36,81.2,,,percent of total billed charges,81.2% of total billed charges,53.2,32.64,,,percent of total billed charges,32.64% of total billed charges,120.62,74,,,percent of total billed charges,74% of total billed charges,120.62,74,,,percent of total billed charges,74% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,109.21,67,,,percent of total billed charges,67% of total billed charges,109.21,67,,,percent of total billed charges,67% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,123.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,53.72,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,146.7,90,,,percent of total billed charges,90% of total billed charges,146.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,144.42,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,130.4,80,,,percent of total billed charges,80% of total billed charges,130.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,148.33,91,,,percent of total billed charges,91% of total billed charges,53.2,32.64,,,percent of total billed charges,32.64% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,54.77,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,149.96,92,,,percent of total billed charges,92% of total billed charges,10.25,149.96,
GENITAL CULTURE,2001437,CDM,306,RC,87070,HCPCS,Outpatient,,,163,138.55,,132.36,81.2,,,percent of total billed charges,81.2% of total billed charges,53.2,32.64,,,percent of total billed charges,32.64% of total billed charges,120.62,74,,,percent of total billed charges,74% of total billed charges,120.62,74,,,percent of total billed charges,74% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,109.21,67,,,percent of total billed charges,67% of total billed charges,109.21,67,,,percent of total billed charges,67% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,123.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,53.72,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,146.7,90,,,percent of total billed charges,90% of total billed charges,146.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,144.42,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,130.4,80,,,percent of total billed charges,80% of total billed charges,130.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,148.33,91,,,percent of total billed charges,91% of total billed charges,53.2,32.64,,,percent of total billed charges,32.64% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,54.77,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,149.96,92,,,percent of total billed charges,92% of total billed charges,10.25,149.96,
UPPER RESPIRATORY CULTURE,2000154,CDM,300,RC,87070,HCPCS,Outpatient,,,163,138.55,,132.36,81.2,,,percent of total billed charges,81.2% of total billed charges,53.2,32.64,,,percent of total billed charges,32.64% of total billed charges,120.62,74,,,percent of total billed charges,74% of total billed charges,120.62,74,,,percent of total billed charges,74% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,109.21,67,,,percent of total billed charges,67% of total billed charges,109.21,67,,,percent of total billed charges,67% of total billed charges,115.73,71,,,percent of total billed charges,71% of total billed charges,123.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,53.72,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,146.7,90,,,percent of total billed charges,90% of total billed charges,146.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,144.42,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,130.4,80,,,percent of total billed charges,80% of total billed charges,130.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,148.33,91,,,percent of total billed charges,91% of total billed charges,53.2,32.64,,,percent of total billed charges,32.64% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,54.77,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,52.16,32,,,percent of total billed charges,32% of total billed charges,52.16,32,,,percent of total billed charges,32% of total billed charges,149.96,92,,,percent of total billed charges,92% of total billed charges,10.25,149.96,
ANAEROBE CULTURE,2000014,CDM,306,RC,87075,HCPCS,Outpatient,,,147,124.95,,119.36,81.2,,,percent of total billed charges,81.2% of total billed charges,47.98,32.64,,,percent of total billed charges,32.64% of total billed charges,108.78,74,,,percent of total billed charges,74% of total billed charges,108.78,74,,,percent of total billed charges,74% of total billed charges,47.04,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,47.04,32,,,percent of total billed charges,32% of total billed charges,104.37,71,,,percent of total billed charges,71% of total billed charges,104.37,71,,,percent of total billed charges,71% of total billed charges,98.49,67,,,percent of total billed charges,67% of total billed charges,98.49,67,,,percent of total billed charges,67% of total billed charges,104.37,71,,,percent of total billed charges,71% of total billed charges,111.72,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,48.45,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,132.3,90,,,percent of total billed charges,90% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,130.24,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,47.04,32,,,percent of total billed charges,32% of total billed charges,117.6,80,,,percent of total billed charges,80% of total billed charges,117.6,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,133.77,91,,,percent of total billed charges,91% of total billed charges,47.98,32.64,,,percent of total billed charges,32.64% of total billed charges,47.04,32,,,percent of total billed charges,32% of total billed charges,49.39,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,47.04,32,,,percent of total billed charges,32% of total billed charges,47.04,32,,,percent of total billed charges,32% of total billed charges,135.24,92,,,percent of total billed charges,92% of total billed charges,10.25,135.24,
AEROBIC ID & SUSCEPTIBILITY BC,2001871,CDM,306,RC,87077,HCPCS,Outpatient,,,73,62.05,,59.28,81.2,,,percent of total billed charges,81.2% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,55.48,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.06,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,64.68,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,66.43,91,,,percent of total billed charges,91% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,24.53,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,67.16,92,,,percent of total billed charges,92% of total billed charges,10.25,67.16,
"ORGANISM ID, BACTERIA",2001195,CDM,306,RC,87077,HCPCS,Outpatient,,,73,62.05,,59.28,81.2,,,percent of total billed charges,81.2% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,54.02,74,,,percent of total billed charges,74% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,48.91,67,,,percent of total billed charges,67% of total billed charges,51.83,71,,,percent of total billed charges,71% of total billed charges,55.48,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.06,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,64.68,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,58.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,66.43,91,,,percent of total billed charges,91% of total billed charges,23.83,32.64,,,percent of total billed charges,32.64% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,24.53,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,23.36,32,,,percent of total billed charges,32% of total billed charges,23.36,32,,,percent of total billed charges,32% of total billed charges,67.16,92,,,percent of total billed charges,92% of total billed charges,10.25,67.16,
GROUP A STREP CULTURE,2001433,CDM,306,RC,87081,HCPCS,Outpatient,,,52,44.2,,42.22,81.2,,,percent of total billed charges,81.2% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,39.52,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.14,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,46.8,90,,,percent of total billed charges,90% of total billed charges,46.8,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,46.07,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,47.32,91,,,percent of total billed charges,91% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,17.47,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,47.84,92,,,percent of total billed charges,92% of total billed charges,10.25,47.84,
GROUP B BETA STREP + RFLX,2001443,CDM,306,RC,87081,HCPCS,Outpatient,,,52,44.2,,42.22,81.2,,,percent of total billed charges,81.2% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,39.52,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.14,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,46.8,90,,,percent of total billed charges,90% of total billed charges,46.8,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,46.07,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,47.32,91,,,percent of total billed charges,91% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,17.47,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,47.84,92,,,percent of total billed charges,92% of total billed charges,10.25,47.84,
MRSA MSSA CULTURE,2001434,CDM,306,RC,87081,HCPCS,Outpatient,,,52,44.2,,42.22,81.2,,,percent of total billed charges,81.2% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,38.48,74,,,percent of total billed charges,74% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,34.84,67,,,percent of total billed charges,67% of total billed charges,36.92,71,,,percent of total billed charges,71% of total billed charges,39.52,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.14,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,46.8,90,,,percent of total billed charges,90% of total billed charges,46.8,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,46.07,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,41.6,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,47.32,91,,,percent of total billed charges,91% of total billed charges,16.97,32.64,,,percent of total billed charges,32.64% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,17.47,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.64,32,,,percent of total billed charges,32% of total billed charges,16.64,32,,,percent of total billed charges,32% of total billed charges,47.84,92,,,percent of total billed charges,92% of total billed charges,10.25,47.84,
URINE CULTURE,2000356,CDM,306,RC,87086,HCPCS,Outpatient,,,71,60.35,,57.65,81.2,,,percent of total billed charges,81.2% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,52.54,74,,,percent of total billed charges,74% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,47.57,67,,,percent of total billed charges,67% of total billed charges,50.41,71,,,percent of total billed charges,71% of total billed charges,53.96,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,23.4,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,63.9,90,,,percent of total billed charges,90% of total billed charges,63.9,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,62.91,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,56.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,64.61,91,,,percent of total billed charges,91% of total billed charges,23.17,32.64,,,percent of total billed charges,32.64% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,23.86,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,22.72,32,,,percent of total billed charges,32% of total billed charges,22.72,32,,,percent of total billed charges,32% of total billed charges,65.32,92,,,percent of total billed charges,92% of total billed charges,10.25,65.32,
"FUNGUS CULTURE SKIN,HAIR,NAILS",2000063,CDM,306,RC,87101,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,10.25,205.16,
FUNGAL CULTURE/SMEAR,2000358,CDM,306,RC,87102,HCPCS,Outpatient,,,149,126.65,,120.99,81.2,,,percent of total billed charges,81.2% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,113.24,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,49.11,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,132.01,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,135.59,91,,,percent of total billed charges,91% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,50.06,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,137.08,92,,,percent of total billed charges,92% of total billed charges,10.25,137.08,
ACID FAST CULTURE AND SMEAR,2000004,CDM,306,RC,87116,HCPCS,Outpatient,,,138,117.3,,112.06,81.2,,,percent of total billed charges,81.2% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,102.12,74,,,percent of total billed charges,74% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,92.46,67,,,percent of total billed charges,67% of total billed charges,97.98,71,,,percent of total billed charges,71% of total billed charges,104.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,45.48,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,122.27,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,110.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,125.58,91,,,percent of total billed charges,91% of total billed charges,45.04,32.64,,,percent of total billed charges,32.64% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,46.37,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,44.16,32,,,percent of total billed charges,32% of total billed charges,44.16,32,,,percent of total billed charges,32% of total billed charges,126.96,92,,,percent of total billed charges,92% of total billed charges,10.25,126.96,
FILMARRAY BCID-2,2001850,CDM,300,RC,87150,HCPCS,Outpatient,,,87,73.95,,70.64,81.2,,,percent of total billed charges,81.2% of total billed charges,28.4,32.64,,,percent of total billed charges,32.64% of total billed charges,64.38,74,,,percent of total billed charges,74% of total billed charges,64.38,74,,,percent of total billed charges,74% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,58.29,67,,,percent of total billed charges,67% of total billed charges,58.29,67,,,percent of total billed charges,67% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,66.12,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,28.68,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,77.08,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,69.6,80,,,percent of total billed charges,80% of total billed charges,69.6,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,79.17,91,,,percent of total billed charges,91% of total billed charges,28.4,32.64,,,percent of total billed charges,32.64% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,29.23,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,80.04,92,,,percent of total billed charges,92% of total billed charges,20.71,80.04,
GROUP B (NAAT) - HDH,2001831,CDM,300,RC,87150,HCPCS,Outpatient,,,87,73.95,,70.64,81.2,,,percent of total billed charges,81.2% of total billed charges,28.4,32.64,,,percent of total billed charges,32.64% of total billed charges,64.38,74,,,percent of total billed charges,74% of total billed charges,64.38,74,,,percent of total billed charges,74% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,58.29,67,,,percent of total billed charges,67% of total billed charges,58.29,67,,,percent of total billed charges,67% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,66.12,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,28.68,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,77.08,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,69.6,80,,,percent of total billed charges,80% of total billed charges,69.6,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,79.17,91,,,percent of total billed charges,91% of total billed charges,28.4,32.64,,,percent of total billed charges,32.64% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,29.23,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,80.04,92,,,percent of total billed charges,92% of total billed charges,20.71,80.04,
PCR,2001442,CDM,300,RC,87150,HCPCS,Outpatient,,,87,73.95,,70.64,81.2,,,percent of total billed charges,81.2% of total billed charges,28.4,32.64,,,percent of total billed charges,32.64% of total billed charges,64.38,74,,,percent of total billed charges,74% of total billed charges,64.38,74,,,percent of total billed charges,74% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,58.29,67,,,percent of total billed charges,67% of total billed charges,58.29,67,,,percent of total billed charges,67% of total billed charges,61.77,71,,,percent of total billed charges,71% of total billed charges,66.12,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,28.68,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,77.08,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,69.6,80,,,percent of total billed charges,80% of total billed charges,69.6,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,79.17,91,,,percent of total billed charges,91% of total billed charges,28.4,32.64,,,percent of total billed charges,32.64% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,29.23,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,27.84,32,,,percent of total billed charges,32% of total billed charges,27.84,32,,,percent of total billed charges,32% of total billed charges,80.04,92,,,percent of total billed charges,92% of total billed charges,20.71,80.04,
"PARASITE ID, WORM",2001495,CDM,306,RC,87169,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,10.25,122.36,
SKIN SCRAPING ECTOPARASITE,2000934,CDM,300,RC,87169,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,10.25,122.36,
OVA AND PARASITES,2000107,CDM,306,RC,87177,HCPCS,Outpatient,,,125,106.25,,101.5,81.2,,,percent of total billed charges,81.2% of total billed charges,40.8,32.64,,,percent of total billed charges,32.64% of total billed charges,92.5,74,,,percent of total billed charges,74% of total billed charges,92.5,74,,,percent of total billed charges,74% of total billed charges,40,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,40,32,,,percent of total billed charges,32% of total billed charges,88.75,71,,,percent of total billed charges,71% of total billed charges,88.75,71,,,percent of total billed charges,71% of total billed charges,83.75,67,,,percent of total billed charges,67% of total billed charges,83.75,67,,,percent of total billed charges,67% of total billed charges,88.75,71,,,percent of total billed charges,71% of total billed charges,95,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,41.2,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,112.5,90,,,percent of total billed charges,90% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,110.75,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,40,32,,,percent of total billed charges,32% of total billed charges,100,80,,,percent of total billed charges,80% of total billed charges,100,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,113.75,91,,,percent of total billed charges,91% of total billed charges,40.8,32.64,,,percent of total billed charges,32.64% of total billed charges,40,32,,,percent of total billed charges,32% of total billed charges,42,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,40,32,,,percent of total billed charges,32% of total billed charges,40,32,,,percent of total billed charges,32% of total billed charges,115,92,,,percent of total billed charges,92% of total billed charges,10.25,115,
SENSITIVITY MIC,2000363,CDM,306,RC,87186,HCPCS,Outpatient,,,41,34.85,,33.29,81.2,,,percent of total billed charges,81.2% of total billed charges,13.38,32.64,,,percent of total billed charges,32.64% of total billed charges,30.34,74,,,percent of total billed charges,74% of total billed charges,30.34,74,,,percent of total billed charges,74% of total billed charges,13.12,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,13.12,32,,,percent of total billed charges,32% of total billed charges,29.11,71,,,percent of total billed charges,71% of total billed charges,29.11,71,,,percent of total billed charges,71% of total billed charges,27.47,67,,,percent of total billed charges,67% of total billed charges,27.47,67,,,percent of total billed charges,67% of total billed charges,29.11,71,,,percent of total billed charges,71% of total billed charges,31.16,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,13.51,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,36.9,90,,,percent of total billed charges,90% of total billed charges,36.9,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,36.33,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,13.12,32,,,percent of total billed charges,32% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,37.31,91,,,percent of total billed charges,91% of total billed charges,13.38,32.64,,,percent of total billed charges,32.64% of total billed charges,13.12,32,,,percent of total billed charges,32% of total billed charges,13.78,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,13.12,32,,,percent of total billed charges,32% of total billed charges,13.12,32,,,percent of total billed charges,32% of total billed charges,37.72,92,,,percent of total billed charges,92% of total billed charges,10.25,37.72,
SUSCEPTIBILITY AEROBIC + ANAEROBIC,2001143,CDM,306,RC,87186,HCPCS,Outpatient,,,41,34.85,,33.29,81.2,,,percent of total billed charges,81.2% of total billed charges,13.38,32.64,,,percent of total billed charges,32.64% of total billed charges,30.34,74,,,percent of total billed charges,74% of total billed charges,30.34,74,,,percent of total billed charges,74% of total billed charges,13.12,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,13.12,32,,,percent of total billed charges,32% of total billed charges,29.11,71,,,percent of total billed charges,71% of total billed charges,29.11,71,,,percent of total billed charges,71% of total billed charges,27.47,67,,,percent of total billed charges,67% of total billed charges,27.47,67,,,percent of total billed charges,67% of total billed charges,29.11,71,,,percent of total billed charges,71% of total billed charges,31.16,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,13.51,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,36.9,90,,,percent of total billed charges,90% of total billed charges,36.9,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,36.33,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,13.12,32,,,percent of total billed charges,32% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,32.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,37.31,91,,,percent of total billed charges,91% of total billed charges,13.38,32.64,,,percent of total billed charges,32.64% of total billed charges,13.12,32,,,percent of total billed charges,32% of total billed charges,13.78,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,13.12,32,,,percent of total billed charges,32% of total billed charges,13.12,32,,,percent of total billed charges,32% of total billed charges,37.72,92,,,percent of total billed charges,92% of total billed charges,10.25,37.72,
EOSIN URINE,2000412,CDM,305,RC,87205,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,10.25,46,
FUNGAL SMEAR,2000488,CDM,306,RC,87205,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,10.25,46,
GRAM STAIN BLD/CSF/SYN,2000069,CDM,306,RC,87205,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,10.25,46,
REFERENCE GRAM STAIN,2001436,CDM,306,RC,87205,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,10.25,46,
SPUTUM CULTURE with Gram Stain,2000360,CDM,306,RC,87205,HCPCS,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,10.25,46,
ACID FAST SMEAR,2000482,CDM,306,RC,87206,HCPCS,Outpatient,,,39,33.15,,31.67,81.2,,,percent of total billed charges,81.2% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,28.86,74,,,percent of total billed charges,74% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,26.13,67,,,percent of total billed charges,67% of total billed charges,27.69,71,,,percent of total billed charges,71% of total billed charges,29.64,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,12.85,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,34.55,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,31.2,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,35.49,91,,,percent of total billed charges,91% of total billed charges,12.73,32.64,,,percent of total billed charges,32.64% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,13.1,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,12.48,32,,,percent of total billed charges,32% of total billed charges,12.48,32,,,percent of total billed charges,32% of total billed charges,35.88,92,,,percent of total billed charges,92% of total billed charges,10.25,35.88,
TRICHROME STAIN O AND P,2001092,CDM,306,RC,87209,HCPCS,Outpatient,,,98,83.3,,79.58,81.2,,,percent of total billed charges,81.2% of total billed charges,31.99,32.64,,,percent of total billed charges,32.64% of total billed charges,72.52,74,,,percent of total billed charges,74% of total billed charges,72.52,74,,,percent of total billed charges,74% of total billed charges,31.36,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,31.36,32,,,percent of total billed charges,32% of total billed charges,69.58,71,,,percent of total billed charges,71% of total billed charges,69.58,71,,,percent of total billed charges,71% of total billed charges,65.66,67,,,percent of total billed charges,67% of total billed charges,65.66,67,,,percent of total billed charges,67% of total billed charges,69.58,71,,,percent of total billed charges,71% of total billed charges,74.48,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,32.3,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,88.2,90,,,percent of total billed charges,90% of total billed charges,88.2,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,86.83,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,31.36,32,,,percent of total billed charges,32% of total billed charges,78.4,80,,,percent of total billed charges,80% of total billed charges,78.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,89.18,91,,,percent of total billed charges,91% of total billed charges,31.99,32.64,,,percent of total billed charges,32.64% of total billed charges,31.36,32,,,percent of total billed charges,32% of total billed charges,32.93,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,31.36,32,,,percent of total billed charges,32% of total billed charges,31.36,32,,,percent of total billed charges,32% of total billed charges,90.16,92,,,percent of total billed charges,92% of total billed charges,10.25,90.16,
KOH PREP,2000243,CDM,300,RC,87210,HCPCS,Outpatient,,,54,45.9,,43.85,81.2,,,percent of total billed charges,81.2% of total billed charges,17.63,32.64,,,percent of total billed charges,32.64% of total billed charges,39.96,74,,,percent of total billed charges,74% of total billed charges,39.96,74,,,percent of total billed charges,74% of total billed charges,17.28,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.28,32,,,percent of total billed charges,32% of total billed charges,38.34,71,,,percent of total billed charges,71% of total billed charges,38.34,71,,,percent of total billed charges,71% of total billed charges,36.18,67,,,percent of total billed charges,67% of total billed charges,36.18,67,,,percent of total billed charges,67% of total billed charges,38.34,71,,,percent of total billed charges,71% of total billed charges,41.04,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.8,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,48.6,90,,,percent of total billed charges,90% of total billed charges,48.6,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,47.84,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.28,32,,,percent of total billed charges,32% of total billed charges,43.2,80,,,percent of total billed charges,80% of total billed charges,43.2,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,49.14,91,,,percent of total billed charges,91% of total billed charges,17.63,32.64,,,percent of total billed charges,32.64% of total billed charges,17.28,32,,,percent of total billed charges,32% of total billed charges,18.14,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.28,32,,,percent of total billed charges,32% of total billed charges,17.28,32,,,percent of total billed charges,32% of total billed charges,49.68,92,,,percent of total billed charges,92% of total billed charges,10.25,49.68,
WET MOUNT,2000148,CDM,306,RC,87210,HCPCS,Outpatient,,,54,45.9,,43.85,81.2,,,percent of total billed charges,81.2% of total billed charges,17.63,32.64,,,percent of total billed charges,32.64% of total billed charges,39.96,74,,,percent of total billed charges,74% of total billed charges,39.96,74,,,percent of total billed charges,74% of total billed charges,17.28,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.28,32,,,percent of total billed charges,32% of total billed charges,38.34,71,,,percent of total billed charges,71% of total billed charges,38.34,71,,,percent of total billed charges,71% of total billed charges,36.18,67,,,percent of total billed charges,67% of total billed charges,36.18,67,,,percent of total billed charges,67% of total billed charges,38.34,71,,,percent of total billed charges,71% of total billed charges,41.04,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.8,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,48.6,90,,,percent of total billed charges,90% of total billed charges,48.6,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,47.84,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.28,32,,,percent of total billed charges,32% of total billed charges,43.2,80,,,percent of total billed charges,80% of total billed charges,43.2,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,49.14,91,,,percent of total billed charges,91% of total billed charges,17.63,32.64,,,percent of total billed charges,32.64% of total billed charges,17.28,32,,,percent of total billed charges,32% of total billed charges,18.14,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,17.28,32,,,percent of total billed charges,32% of total billed charges,17.28,32,,,percent of total billed charges,32% of total billed charges,49.68,92,,,percent of total billed charges,92% of total billed charges,10.25,49.68,
VIRAL CULTURE RAPID RESPIRATORY,2001116,CDM,306,RC,87252,HCPCS,Outpatient,,,145,123.25,,117.74,81.2,,,percent of total billed charges,81.2% of total billed charges,47.33,32.64,,,percent of total billed charges,32.64% of total billed charges,107.3,74,,,percent of total billed charges,74% of total billed charges,107.3,74,,,percent of total billed charges,74% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,97.15,67,,,percent of total billed charges,67% of total billed charges,97.15,67,,,percent of total billed charges,67% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,110.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,47.79,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,130.5,90,,,percent of total billed charges,90% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,128.47,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,131.95,91,,,percent of total billed charges,91% of total billed charges,47.33,32.64,,,percent of total billed charges,32.64% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,48.72,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,133.4,92,,,percent of total billed charges,92% of total billed charges,20.71,133.4,
"VIRAL CULTURE, GENERAL",2000205,CDM,306,RC,87252,HCPCS,Outpatient,,,145,123.25,,117.74,81.2,,,percent of total billed charges,81.2% of total billed charges,47.33,32.64,,,percent of total billed charges,32.64% of total billed charges,107.3,74,,,percent of total billed charges,74% of total billed charges,107.3,74,,,percent of total billed charges,74% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,97.15,67,,,percent of total billed charges,67% of total billed charges,97.15,67,,,percent of total billed charges,67% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,110.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,47.79,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,130.5,90,,,percent of total billed charges,90% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,128.47,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,131.95,91,,,percent of total billed charges,91% of total billed charges,47.33,32.64,,,percent of total billed charges,32.64% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,48.72,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,133.4,92,,,percent of total billed charges,92% of total billed charges,20.71,133.4,
CRYPTOSPORIDIUM ANTIGEN,2000724,CDM,300,RC,87328,HCPCS,Outpatient,,,129,109.65,,104.75,81.2,,,percent of total billed charges,81.2% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,98.04,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,42.52,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,116.1,90,,,percent of total billed charges,90% of total billed charges,116.1,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,114.29,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,117.39,91,,,percent of total billed charges,91% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,43.34,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,118.68,92,,,percent of total billed charges,92% of total billed charges,10.25,118.68,
GIARDIA ANTIGEN,2000498,CDM,306,RC,87329,HCPCS,Outpatient,,,129,109.65,,104.75,81.2,,,percent of total billed charges,81.2% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,98.04,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,42.52,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,116.1,90,,,percent of total billed charges,90% of total billed charges,116.1,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,114.29,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,117.39,91,,,percent of total billed charges,91% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,43.34,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,118.68,92,,,percent of total billed charges,92% of total billed charges,10.25,118.68,
H. PYLORI AG STOOL,2000828,CDM,300,RC,87338,HCPCS,Outpatient,,,113,96.05,,91.76,81.2,,,percent of total billed charges,81.2% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,85.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.24,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,100.12,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,102.83,91,,,percent of total billed charges,91% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,37.97,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,103.96,92,,,percent of total billed charges,92% of total billed charges,10.25,103.96,
CLOTEST (HELICOBACTER PYLORI),2000368,CDM,306,RC,87339,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,10.25,41.4,
HEPATITIS B ANTIGEN SURFACE,2000153,CDM,306,RC,87340,HCPCS,Outpatient,,,22,18.7,,17.86,81.2,,,percent of total billed charges,81.2% of total billed charges,7.18,32.64,,,percent of total billed charges,32.64% of total billed charges,16.28,74,,,percent of total billed charges,74% of total billed charges,16.28,74,,,percent of total billed charges,74% of total billed charges,7.04,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.04,32,,,percent of total billed charges,32% of total billed charges,15.62,71,,,percent of total billed charges,71% of total billed charges,15.62,71,,,percent of total billed charges,71% of total billed charges,14.74,67,,,percent of total billed charges,67% of total billed charges,14.74,67,,,percent of total billed charges,67% of total billed charges,15.62,71,,,percent of total billed charges,71% of total billed charges,16.72,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.25,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,19.8,90,,,percent of total billed charges,90% of total billed charges,19.8,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,19.49,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.04,32,,,percent of total billed charges,32% of total billed charges,17.6,80,,,percent of total billed charges,80% of total billed charges,17.6,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,20.02,91,,,percent of total billed charges,91% of total billed charges,7.18,32.64,,,percent of total billed charges,32.64% of total billed charges,7.04,32,,,percent of total billed charges,32% of total billed charges,7.39,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.04,32,,,percent of total billed charges,32% of total billed charges,7.04,32,,,percent of total billed charges,32% of total billed charges,20.24,92,,,percent of total billed charges,92% of total billed charges,7.04,20.24,
HEPATITIS BE ANTIGEN,2000077,CDM,306,RC,87350,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,10.25,74.52,
HISTOPLASMA ANTIGEN URINE,2001079,CDM,306,RC,87385,HCPCS,Outpatient,,,205,174.25,,166.46,81.2,,,percent of total billed charges,81.2% of total billed charges,66.91,32.64,,,percent of total billed charges,32.64% of total billed charges,151.7,74,,,percent of total billed charges,74% of total billed charges,151.7,74,,,percent of total billed charges,74% of total billed charges,65.6,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,65.6,32,,,percent of total billed charges,32% of total billed charges,145.55,71,,,percent of total billed charges,71% of total billed charges,145.55,71,,,percent of total billed charges,71% of total billed charges,137.35,67,,,percent of total billed charges,67% of total billed charges,137.35,67,,,percent of total billed charges,67% of total billed charges,145.55,71,,,percent of total billed charges,71% of total billed charges,155.8,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,67.57,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,184.5,90,,,percent of total billed charges,90% of total billed charges,184.5,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,181.63,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,65.6,32,,,percent of total billed charges,32% of total billed charges,164,80,,,percent of total billed charges,80% of total billed charges,164,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,186.55,91,,,percent of total billed charges,91% of total billed charges,66.91,32.64,,,percent of total billed charges,32.64% of total billed charges,65.6,32,,,percent of total billed charges,32% of total billed charges,68.88,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,65.6,32,,,percent of total billed charges,32% of total billed charges,65.6,32,,,percent of total billed charges,32% of total billed charges,188.6,92,,,percent of total billed charges,92% of total billed charges,10.25,188.6,
HIV Screen 4th Gen wRfx,2001388,CDM,300,RC,87389,HCPCS,Outpatient,,,113,96.05,,91.76,81.2,,,percent of total billed charges,81.2% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,85.88,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.24,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,100.12,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,102.83,91,,,percent of total billed charges,91% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,37.97,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,103.96,92,,,percent of total billed charges,92% of total billed charges,10.25,103.96,
"INFLUENZA A/B ANTIGEN, NASAL",2000736,CDM,300,RC,87400,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,14.22,79.12,
INFLUENZA B ANTIGEN,2000737,CDM,300,RC,87400,HCPCS,Outpatient,,,86,73.1,,69.83,81.2,,,percent of total billed charges,81.2% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,63.64,74,,,percent of total billed charges,74% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,57.62,67,,,percent of total billed charges,67% of total billed charges,61.06,71,,,percent of total billed charges,71% of total billed charges,65.36,76,,,percent of total billed charges,76% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,28.35,32.96,,,percent of total billed charges,32.96% of total billed charges,14.93,105,,,Fee Schedule,pays based on EAPG rates,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,76.2,88.6,,,percent of total billed charges,88.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,68.8,80,,,percent of total billed charges,80% of total billed charges,14.22,100,,,Fee Schedule,pays based on EAPG rates,78.26,91,,,percent of total billed charges,91% of total billed charges,28.07,32.64,,,percent of total billed charges,32.64% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,28.9,33.6,,,percent of total billed charges,33.6% of total billed charges,14.64,103,,,Fee Schedule,pays based on EAPG rates,27.52,32,,,percent of total billed charges,32% of total billed charges,27.52,32,,,percent of total billed charges,32% of total billed charges,79.12,92,,,percent of total billed charges,92% of total billed charges,14.22,79.12,
RSV RESP. SYNCYTIAL VIRUS,2000404,CDM,306,RC,87420,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,10.25,85.56,
ROTA VIRUS,2000295,CDM,306,RC,87425,HCPCS,Outpatient,,,67,56.95,,54.4,81.2,,,percent of total billed charges,81.2% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,49.58,74,,,percent of total billed charges,74% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,44.89,67,,,percent of total billed charges,67% of total billed charges,47.57,71,,,percent of total billed charges,71% of total billed charges,50.92,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,22.08,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,60.3,90,,,percent of total billed charges,90% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,59.36,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,53.6,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,60.97,91,,,percent of total billed charges,91% of total billed charges,21.87,32.64,,,percent of total billed charges,32.64% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,22.51,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,21.44,32,,,percent of total billed charges,32% of total billed charges,21.44,32,,,percent of total billed charges,32% of total billed charges,61.64,92,,,percent of total billed charges,92% of total billed charges,10.25,61.64,
RAPID STREP SCREEN,2000211,CDM,306,RC,87430,HCPCS,Outpatient,,,118,100.3,,95.82,81.2,,,percent of total billed charges,81.2% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,89.68,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,38.89,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,104.55,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,107.38,91,,,percent of total billed charges,91% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,39.65,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,108.56,92,,,percent of total billed charges,92% of total billed charges,10.25,108.56,
"LEGIONELLA URINE, ANTIGEN",2000464,CDM,306,RC,87449,HCPCS,Outpatient,,,119,101.15,,96.63,81.2,,,percent of total billed charges,81.2% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,90.44,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,39.22,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,105.43,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,108.29,91,,,percent of total billed charges,91% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,39.98,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,109.48,92,,,percent of total billed charges,92% of total billed charges,10.25,109.48,
LYMES DISEASE BY PCR CSF OR WHOLE BLOOD,2000684,CDM,306,RC,87476,HCPCS,Outpatient,,,439,373.15,,356.47,81.2,,,percent of total billed charges,81.2% of total billed charges,143.29,32.64,,,percent of total billed charges,32.64% of total billed charges,324.86,74,,,percent of total billed charges,74% of total billed charges,324.86,74,,,percent of total billed charges,74% of total billed charges,140.48,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,140.48,32,,,percent of total billed charges,32% of total billed charges,311.69,71,,,percent of total billed charges,71% of total billed charges,311.69,71,,,percent of total billed charges,71% of total billed charges,294.13,67,,,percent of total billed charges,67% of total billed charges,294.13,67,,,percent of total billed charges,67% of total billed charges,311.69,71,,,percent of total billed charges,71% of total billed charges,333.64,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,144.69,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,395.1,90,,,percent of total billed charges,90% of total billed charges,395.1,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,388.95,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,140.48,32,,,percent of total billed charges,32% of total billed charges,351.2,80,,,percent of total billed charges,80% of total billed charges,351.2,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,399.49,91,,,percent of total billed charges,91% of total billed charges,143.29,32.64,,,percent of total billed charges,32.64% of total billed charges,140.48,32,,,percent of total billed charges,32% of total billed charges,147.5,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,140.48,32,,,percent of total billed charges,32% of total billed charges,140.48,32,,,percent of total billed charges,32% of total billed charges,403.88,92,,,percent of total billed charges,92% of total billed charges,20.71,403.88,
CANDIDA SPECIES,2001456,CDM,306,RC,87480,HCPCS,Outpatient,,,76,64.6,,61.71,81.2,,,percent of total billed charges,81.2% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,57.76,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,25.05,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,67.34,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,69.16,91,,,percent of total billed charges,91% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,25.54,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,69.92,92,,,percent of total billed charges,92% of total billed charges,10.25,69.92,
CHLAMYDIA APTIMA PROBE,2000739,CDM,300,RC,87491,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,20.71,74.52,
C DIFF PCR,2001405,CDM,306,RC,87493,HCPCS,Outpatient,,,228,193.8,,185.14,81.2,,,percent of total billed charges,81.2% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.96,32,,,percent of total billed charges,32% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,173.28,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,75.15,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,202.01,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.96,32,,,percent of total billed charges,32% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,207.48,91,,,percent of total billed charges,91% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,76.61,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.96,32,,,percent of total billed charges,32% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,209.76,92,,,percent of total billed charges,92% of total billed charges,20.71,209.76,
C DIFF/EPI,2001832,CDM,306,RC,87493,HCPCS,Outpatient,,,228,193.8,,185.14,81.2,,,percent of total billed charges,81.2% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.96,32,,,percent of total billed charges,32% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,173.28,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,75.15,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,202.01,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.96,32,,,percent of total billed charges,32% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,207.48,91,,,percent of total billed charges,91% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,76.61,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.96,32,,,percent of total billed charges,32% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,209.76,92,,,percent of total billed charges,92% of total billed charges,20.71,209.76,
CMV PCR QUAL,2001191,CDM,306,RC,87496,HCPCS,Outpatient,,,275,233.75,,223.3,81.2,,,percent of total billed charges,81.2% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,209,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,90.64,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,247.5,90,,,percent of total billed charges,90% of total billed charges,247.5,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,243.65,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,250.25,91,,,percent of total billed charges,91% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,92.4,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,253,92,,,percent of total billed charges,92% of total billed charges,20.71,253,
CYTOMEGALOVIRUS DNA CMV,2000703,CDM,306,RC,87496,HCPCS,Outpatient,,,275,233.75,,223.3,81.2,,,percent of total billed charges,81.2% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,209,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,90.64,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,247.5,90,,,percent of total billed charges,90% of total billed charges,247.5,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,243.65,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,250.25,91,,,percent of total billed charges,91% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,92.4,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,253,92,,,percent of total billed charges,92% of total billed charges,20.71,253,
CMV QUAN DNA PCR PLASMA,2001689,CDM,300,RC,87497,HCPCS,Outpatient,,,432,367.2,,350.78,81.2,,,percent of total billed charges,81.2% of total billed charges,141,32.64,,,percent of total billed charges,32.64% of total billed charges,319.68,74,,,percent of total billed charges,74% of total billed charges,319.68,74,,,percent of total billed charges,74% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,289.44,67,,,percent of total billed charges,67% of total billed charges,289.44,67,,,percent of total billed charges,67% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,328.32,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,142.39,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,388.8,90,,,percent of total billed charges,90% of total billed charges,388.8,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,382.75,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,345.6,80,,,percent of total billed charges,80% of total billed charges,345.6,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,393.12,91,,,percent of total billed charges,91% of total billed charges,141,32.64,,,percent of total billed charges,32.64% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,145.15,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,397.44,92,,,percent of total billed charges,92% of total billed charges,20.71,397.44,
CMV QUAN DNA PCR URINE,2001046,CDM,300,RC,87497,HCPCS,Outpatient,,,432,367.2,,350.78,81.2,,,percent of total billed charges,81.2% of total billed charges,141,32.64,,,percent of total billed charges,32.64% of total billed charges,319.68,74,,,percent of total billed charges,74% of total billed charges,319.68,74,,,percent of total billed charges,74% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,289.44,67,,,percent of total billed charges,67% of total billed charges,289.44,67,,,percent of total billed charges,67% of total billed charges,306.72,71,,,percent of total billed charges,71% of total billed charges,328.32,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,142.39,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,388.8,90,,,percent of total billed charges,90% of total billed charges,388.8,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,382.75,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,345.6,80,,,percent of total billed charges,80% of total billed charges,345.6,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,393.12,91,,,percent of total billed charges,91% of total billed charges,141,32.64,,,percent of total billed charges,32.64% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,145.15,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,138.24,32,,,percent of total billed charges,32% of total billed charges,138.24,32,,,percent of total billed charges,32% of total billed charges,397.44,92,,,percent of total billed charges,92% of total billed charges,20.71,397.44,
ENTEROVIRUS PCR,2001027,CDM,300,RC,87498,HCPCS,Outpatient,,,484,411.4,,393.01,81.2,,,percent of total billed charges,81.2% of total billed charges,157.98,32.64,,,percent of total billed charges,32.64% of total billed charges,358.16,74,,,percent of total billed charges,74% of total billed charges,358.16,74,,,percent of total billed charges,74% of total billed charges,154.88,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,154.88,32,,,percent of total billed charges,32% of total billed charges,343.64,71,,,percent of total billed charges,71% of total billed charges,343.64,71,,,percent of total billed charges,71% of total billed charges,324.28,67,,,percent of total billed charges,67% of total billed charges,324.28,67,,,percent of total billed charges,67% of total billed charges,343.64,71,,,percent of total billed charges,71% of total billed charges,367.84,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,159.53,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,435.6,90,,,percent of total billed charges,90% of total billed charges,435.6,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,428.82,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,154.88,32,,,percent of total billed charges,32% of total billed charges,387.2,80,,,percent of total billed charges,80% of total billed charges,387.2,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,440.44,91,,,percent of total billed charges,91% of total billed charges,157.98,32.64,,,percent of total billed charges,32.64% of total billed charges,154.88,32,,,percent of total billed charges,32% of total billed charges,162.62,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,154.88,32,,,percent of total billed charges,32% of total billed charges,154.88,32,,,percent of total billed charges,32% of total billed charges,445.28,92,,,percent of total billed charges,92% of total billed charges,20.71,445.28,
GARDNERELLA VAGINALIS,2001457,CDM,306,RC,87510,HCPCS,Outpatient,,,76,64.6,,61.71,81.2,,,percent of total billed charges,81.2% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,57.76,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,25.05,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,67.34,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,69.16,91,,,percent of total billed charges,91% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,25.54,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,69.92,92,,,percent of total billed charges,92% of total billed charges,10.25,69.92,
HEPATITIS B REAL TIME PCR,2000766,CDM,300,RC,87517,HCPCS,Outpatient,,,191,162.35,,155.09,81.2,,,percent of total billed charges,81.2% of total billed charges,62.34,32.64,,,percent of total billed charges,32.64% of total billed charges,141.34,74,,,percent of total billed charges,74% of total billed charges,141.34,74,,,percent of total billed charges,74% of total billed charges,61.12,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,61.12,32,,,percent of total billed charges,32% of total billed charges,135.61,71,,,percent of total billed charges,71% of total billed charges,135.61,71,,,percent of total billed charges,71% of total billed charges,127.97,67,,,percent of total billed charges,67% of total billed charges,127.97,67,,,percent of total billed charges,67% of total billed charges,135.61,71,,,percent of total billed charges,71% of total billed charges,145.16,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,62.95,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,169.23,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,61.12,32,,,percent of total billed charges,32% of total billed charges,152.8,80,,,percent of total billed charges,80% of total billed charges,152.8,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,173.81,91,,,percent of total billed charges,91% of total billed charges,62.34,32.64,,,percent of total billed charges,32.64% of total billed charges,61.12,32,,,percent of total billed charges,32% of total billed charges,64.18,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,61.12,32,,,percent of total billed charges,32% of total billed charges,61.12,32,,,percent of total billed charges,32% of total billed charges,175.72,92,,,percent of total billed charges,92% of total billed charges,20.71,175.72,
HCV RNA PCR QL (RFX TO QUANT),2001205,CDM,306,RC,87521,HCPCS,Outpatient,,,488,414.8,,396.26,81.2,,,percent of total billed charges,81.2% of total billed charges,159.28,32.64,,,percent of total billed charges,32.64% of total billed charges,361.12,74,,,percent of total billed charges,74% of total billed charges,361.12,74,,,percent of total billed charges,74% of total billed charges,156.16,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,156.16,32,,,percent of total billed charges,32% of total billed charges,346.48,71,,,percent of total billed charges,71% of total billed charges,346.48,71,,,percent of total billed charges,71% of total billed charges,326.96,67,,,percent of total billed charges,67% of total billed charges,326.96,67,,,percent of total billed charges,67% of total billed charges,346.48,71,,,percent of total billed charges,71% of total billed charges,370.88,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,160.84,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,439.2,90,,,percent of total billed charges,90% of total billed charges,439.2,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,432.37,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,156.16,32,,,percent of total billed charges,32% of total billed charges,390.4,80,,,percent of total billed charges,80% of total billed charges,390.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,444.08,91,,,percent of total billed charges,91% of total billed charges,159.28,32.64,,,percent of total billed charges,32.64% of total billed charges,156.16,32,,,percent of total billed charges,32% of total billed charges,163.97,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,156.16,32,,,percent of total billed charges,32% of total billed charges,156.16,32,,,percent of total billed charges,32% of total billed charges,448.96,92,,,percent of total billed charges,92% of total billed charges,20.71,448.96,
HEPATITIS C PCR/RNA QUAL,2000509,CDM,306,RC,87521,HCPCS,Outpatient,,,488,414.8,,396.26,81.2,,,percent of total billed charges,81.2% of total billed charges,159.28,32.64,,,percent of total billed charges,32.64% of total billed charges,361.12,74,,,percent of total billed charges,74% of total billed charges,361.12,74,,,percent of total billed charges,74% of total billed charges,156.16,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,156.16,32,,,percent of total billed charges,32% of total billed charges,346.48,71,,,percent of total billed charges,71% of total billed charges,346.48,71,,,percent of total billed charges,71% of total billed charges,326.96,67,,,percent of total billed charges,67% of total billed charges,326.96,67,,,percent of total billed charges,67% of total billed charges,346.48,71,,,percent of total billed charges,71% of total billed charges,370.88,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,160.84,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,439.2,90,,,percent of total billed charges,90% of total billed charges,439.2,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,432.37,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,156.16,32,,,percent of total billed charges,32% of total billed charges,390.4,80,,,percent of total billed charges,80% of total billed charges,390.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,444.08,91,,,percent of total billed charges,91% of total billed charges,159.28,32.64,,,percent of total billed charges,32.64% of total billed charges,156.16,32,,,percent of total billed charges,32% of total billed charges,163.97,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,156.16,32,,,percent of total billed charges,32% of total billed charges,156.16,32,,,percent of total billed charges,32% of total billed charges,448.96,92,,,percent of total billed charges,92% of total billed charges,20.71,448.96,
HEPATITIS C RNA QUALITATIVE,2000745,CDM,300,RC,87521,HCPCS,Outpatient,,,488,414.8,,396.26,81.2,,,percent of total billed charges,81.2% of total billed charges,159.28,32.64,,,percent of total billed charges,32.64% of total billed charges,361.12,74,,,percent of total billed charges,74% of total billed charges,361.12,74,,,percent of total billed charges,74% of total billed charges,156.16,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,156.16,32,,,percent of total billed charges,32% of total billed charges,346.48,71,,,percent of total billed charges,71% of total billed charges,346.48,71,,,percent of total billed charges,71% of total billed charges,326.96,67,,,percent of total billed charges,67% of total billed charges,326.96,67,,,percent of total billed charges,67% of total billed charges,346.48,71,,,percent of total billed charges,71% of total billed charges,370.88,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,160.84,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,439.2,90,,,percent of total billed charges,90% of total billed charges,439.2,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,432.37,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,156.16,32,,,percent of total billed charges,32% of total billed charges,390.4,80,,,percent of total billed charges,80% of total billed charges,390.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,444.08,91,,,percent of total billed charges,91% of total billed charges,159.28,32.64,,,percent of total billed charges,32.64% of total billed charges,156.16,32,,,percent of total billed charges,32% of total billed charges,163.97,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,156.16,32,,,percent of total billed charges,32% of total billed charges,156.16,32,,,percent of total billed charges,32% of total billed charges,448.96,92,,,percent of total billed charges,92% of total billed charges,20.71,448.96,
HCV RNA BY PCR QN REX GENOTYPING,2001201,CDM,306,RC,87522,HCPCS,Outpatient,,,598,508.3,,485.58,81.2,,,percent of total billed charges,81.2% of total billed charges,195.19,32.64,,,percent of total billed charges,32.64% of total billed charges,442.52,74,,,percent of total billed charges,74% of total billed charges,442.52,74,,,percent of total billed charges,74% of total billed charges,191.36,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,191.36,32,,,percent of total billed charges,32% of total billed charges,424.58,71,,,percent of total billed charges,71% of total billed charges,424.58,71,,,percent of total billed charges,71% of total billed charges,400.66,67,,,percent of total billed charges,67% of total billed charges,400.66,67,,,percent of total billed charges,67% of total billed charges,424.58,71,,,percent of total billed charges,71% of total billed charges,454.48,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,197.1,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,538.2,90,,,percent of total billed charges,90% of total billed charges,538.2,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,529.83,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,191.36,32,,,percent of total billed charges,32% of total billed charges,478.4,80,,,percent of total billed charges,80% of total billed charges,478.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,544.18,91,,,percent of total billed charges,91% of total billed charges,195.19,32.64,,,percent of total billed charges,32.64% of total billed charges,191.36,32,,,percent of total billed charges,32% of total billed charges,200.93,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,191.36,32,,,percent of total billed charges,32% of total billed charges,191.36,32,,,percent of total billed charges,32% of total billed charges,550.16,92,,,percent of total billed charges,92% of total billed charges,20.71,550.16,
"HEPATITIS C PCR/RNA, VIRAL LOAD",2000508,CDM,306,RC,87522,HCPCS,Outpatient,,,598,508.3,,485.58,81.2,,,percent of total billed charges,81.2% of total billed charges,195.19,32.64,,,percent of total billed charges,32.64% of total billed charges,442.52,74,,,percent of total billed charges,74% of total billed charges,442.52,74,,,percent of total billed charges,74% of total billed charges,191.36,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,191.36,32,,,percent of total billed charges,32% of total billed charges,424.58,71,,,percent of total billed charges,71% of total billed charges,424.58,71,,,percent of total billed charges,71% of total billed charges,400.66,67,,,percent of total billed charges,67% of total billed charges,400.66,67,,,percent of total billed charges,67% of total billed charges,424.58,71,,,percent of total billed charges,71% of total billed charges,454.48,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,197.1,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,538.2,90,,,percent of total billed charges,90% of total billed charges,538.2,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,529.83,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,191.36,32,,,percent of total billed charges,32% of total billed charges,478.4,80,,,percent of total billed charges,80% of total billed charges,478.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,544.18,91,,,percent of total billed charges,91% of total billed charges,195.19,32.64,,,percent of total billed charges,32.64% of total billed charges,191.36,32,,,percent of total billed charges,32% of total billed charges,200.93,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,191.36,32,,,percent of total billed charges,32% of total billed charges,191.36,32,,,percent of total billed charges,32% of total billed charges,550.16,92,,,percent of total billed charges,92% of total billed charges,20.71,550.16,
HEPATITIS C RNA QUANT/VIRAL,2000744,CDM,300,RC,87522,HCPCS,Outpatient,,,598,508.3,,485.58,81.2,,,percent of total billed charges,81.2% of total billed charges,195.19,32.64,,,percent of total billed charges,32.64% of total billed charges,442.52,74,,,percent of total billed charges,74% of total billed charges,442.52,74,,,percent of total billed charges,74% of total billed charges,191.36,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,191.36,32,,,percent of total billed charges,32% of total billed charges,424.58,71,,,percent of total billed charges,71% of total billed charges,424.58,71,,,percent of total billed charges,71% of total billed charges,400.66,67,,,percent of total billed charges,67% of total billed charges,400.66,67,,,percent of total billed charges,67% of total billed charges,424.58,71,,,percent of total billed charges,71% of total billed charges,454.48,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,197.1,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,538.2,90,,,percent of total billed charges,90% of total billed charges,538.2,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,529.83,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,191.36,32,,,percent of total billed charges,32% of total billed charges,478.4,80,,,percent of total billed charges,80% of total billed charges,478.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,544.18,91,,,percent of total billed charges,91% of total billed charges,195.19,32.64,,,percent of total billed charges,32.64% of total billed charges,191.36,32,,,percent of total billed charges,32% of total billed charges,200.93,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,191.36,32,,,percent of total billed charges,32% of total billed charges,191.36,32,,,percent of total billed charges,32% of total billed charges,550.16,92,,,percent of total billed charges,92% of total billed charges,20.71,550.16,
HERPES SIMPLEX BY PCR,2000466,CDM,306,RC,87529,HCPCS,Outpatient,,,227,192.95,,184.32,81.2,,,percent of total billed charges,81.2% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,172.52,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,74.82,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,201.12,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,206.57,91,,,percent of total billed charges,91% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,76.27,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,208.84,92,,,percent of total billed charges,92% of total billed charges,20.71,208.84,
HIV RNA REAL TIME PCR,2001727,CDM,300,RC,87536,HCPCS,Outpatient,,,323,274.55,,262.28,81.2,,,percent of total billed charges,81.2% of total billed charges,105.43,32.64,,,percent of total billed charges,32.64% of total billed charges,239.02,74,,,percent of total billed charges,74% of total billed charges,239.02,74,,,percent of total billed charges,74% of total billed charges,103.36,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,103.36,32,,,percent of total billed charges,32% of total billed charges,229.33,71,,,percent of total billed charges,71% of total billed charges,229.33,71,,,percent of total billed charges,71% of total billed charges,216.41,67,,,percent of total billed charges,67% of total billed charges,216.41,67,,,percent of total billed charges,67% of total billed charges,229.33,71,,,percent of total billed charges,71% of total billed charges,245.48,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,106.46,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,290.7,90,,,percent of total billed charges,90% of total billed charges,290.7,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,286.18,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,103.36,32,,,percent of total billed charges,32% of total billed charges,258.4,80,,,percent of total billed charges,80% of total billed charges,258.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,293.93,91,,,percent of total billed charges,91% of total billed charges,105.43,32.64,,,percent of total billed charges,32.64% of total billed charges,103.36,32,,,percent of total billed charges,32% of total billed charges,108.53,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,103.36,32,,,percent of total billed charges,32% of total billed charges,103.36,32,,,percent of total billed charges,32% of total billed charges,297.16,92,,,percent of total billed charges,92% of total billed charges,20.71,297.16,
"HIV,QUANTITATIVE PCR,graph",2000581,CDM,306,RC,87536,HCPCS,Outpatient,,,323,274.55,,262.28,81.2,,,percent of total billed charges,81.2% of total billed charges,105.43,32.64,,,percent of total billed charges,32.64% of total billed charges,239.02,74,,,percent of total billed charges,74% of total billed charges,239.02,74,,,percent of total billed charges,74% of total billed charges,103.36,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,103.36,32,,,percent of total billed charges,32% of total billed charges,229.33,71,,,percent of total billed charges,71% of total billed charges,229.33,71,,,percent of total billed charges,71% of total billed charges,216.41,67,,,percent of total billed charges,67% of total billed charges,216.41,67,,,percent of total billed charges,67% of total billed charges,229.33,71,,,percent of total billed charges,71% of total billed charges,245.48,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,106.46,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,290.7,90,,,percent of total billed charges,90% of total billed charges,290.7,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,286.18,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,103.36,32,,,percent of total billed charges,32% of total billed charges,258.4,80,,,percent of total billed charges,80% of total billed charges,258.4,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,293.93,91,,,percent of total billed charges,91% of total billed charges,105.43,32.64,,,percent of total billed charges,32.64% of total billed charges,103.36,32,,,percent of total billed charges,32% of total billed charges,108.53,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,103.36,32,,,percent of total billed charges,32% of total billed charges,103.36,32,,,percent of total billed charges,32% of total billed charges,297.16,92,,,percent of total billed charges,92% of total billed charges,20.71,297.16,
GC,2001220,CDM,306,RC,87591,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,20.71,74.52,
"GC  PROBE,  APTIMA",2000740,CDM,300,RC,87591,HCPCS,Outpatient,,,81,68.85,,65.77,81.2,,,percent of total billed charges,81.2% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,59.94,74,,,percent of total billed charges,74% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,54.27,67,,,percent of total billed charges,67% of total billed charges,57.51,71,,,percent of total billed charges,71% of total billed charges,61.56,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,26.7,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,71.77,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,64.8,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,73.71,91,,,percent of total billed charges,91% of total billed charges,26.44,32.64,,,percent of total billed charges,32.64% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,27.22,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.92,32,,,percent of total billed charges,32% of total billed charges,25.92,32,,,percent of total billed charges,32% of total billed charges,74.52,92,,,percent of total billed charges,92% of total billed charges,20.71,74.52,
MONKEY POX / ORTHO POX,2001856,CDM,300,RC,87593,HCPCS,Outpatient,,,320,272,,259.84,81.2,,,percent of total billed charges,81.2% of total billed charges,104.45,32.64,,,percent of total billed charges,32.64% of total billed charges,236.8,74,,,percent of total billed charges,74% of total billed charges,236.8,74,,,percent of total billed charges,74% of total billed charges,102.4,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,102.4,32,,,percent of total billed charges,32% of total billed charges,227.2,71,,,percent of total billed charges,71% of total billed charges,227.2,71,,,percent of total billed charges,71% of total billed charges,214.4,67,,,percent of total billed charges,67% of total billed charges,214.4,67,,,percent of total billed charges,67% of total billed charges,227.2,71,,,percent of total billed charges,71% of total billed charges,243.2,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,105.47,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,288,90,,,percent of total billed charges,90% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,283.52,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,102.4,32,,,percent of total billed charges,32% of total billed charges,256,80,,,percent of total billed charges,80% of total billed charges,256,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,291.2,91,,,percent of total billed charges,91% of total billed charges,104.45,32.64,,,percent of total billed charges,32.64% of total billed charges,102.4,32,,,percent of total billed charges,32% of total billed charges,107.52,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,102.4,32,,,percent of total billed charges,32% of total billed charges,102.4,32,,,percent of total billed charges,32% of total billed charges,294.4,92,,,percent of total billed charges,92% of total billed charges,102.4,294.4,
HUMAN PAPILLOMA VIRUS HIGH RISK,2000583,CDM,301,RC,87625,HCPCS,Outpatient,,,245,208.25,,198.94,81.2,,,percent of total billed charges,81.2% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,186.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,80.75,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,220.5,90,,,percent of total billed charges,90% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,217.07,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,222.95,91,,,percent of total billed charges,91% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,82.32,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,225.4,92,,,percent of total billed charges,92% of total billed charges,20.71,225.4,
RSV RAPID,2001857,CDM,300,RC,87634,HCPCS,Outpatient,,,217,184.45,,176.2,81.2,,,percent of total billed charges,81.2% of total billed charges,70.83,32.64,,,percent of total billed charges,32.64% of total billed charges,160.58,74,,,percent of total billed charges,74% of total billed charges,160.58,74,,,percent of total billed charges,74% of total billed charges,69.44,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,69.44,32,,,percent of total billed charges,32% of total billed charges,154.07,71,,,percent of total billed charges,71% of total billed charges,154.07,71,,,percent of total billed charges,71% of total billed charges,145.39,67,,,percent of total billed charges,67% of total billed charges,145.39,67,,,percent of total billed charges,67% of total billed charges,154.07,71,,,percent of total billed charges,71% of total billed charges,164.92,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,71.52,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,195.3,90,,,percent of total billed charges,90% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,192.26,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,69.44,32,,,percent of total billed charges,32% of total billed charges,173.6,80,,,percent of total billed charges,80% of total billed charges,173.6,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,197.47,91,,,percent of total billed charges,91% of total billed charges,70.83,32.64,,,percent of total billed charges,32.64% of total billed charges,69.44,32,,,percent of total billed charges,32% of total billed charges,72.91,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,69.44,32,,,percent of total billed charges,32% of total billed charges,69.44,32,,,percent of total billed charges,32% of total billed charges,199.64,92,,,percent of total billed charges,92% of total billed charges,20.71,199.64,
COVID19,2001806,CDM,306,RC,87635,HCPCS,Outpatient,,,244,207.4,,198.13,81.2,,,percent of total billed charges,81.2% of total billed charges,79.64,32.64,,,percent of total billed charges,32.64% of total billed charges,180.56,74,,,percent of total billed charges,74% of total billed charges,180.56,74,,,percent of total billed charges,74% of total billed charges,78.08,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,78.08,32,,,percent of total billed charges,32% of total billed charges,173.24,71,,,percent of total billed charges,71% of total billed charges,173.24,71,,,percent of total billed charges,71% of total billed charges,163.48,67,,,percent of total billed charges,67% of total billed charges,163.48,67,,,percent of total billed charges,67% of total billed charges,173.24,71,,,percent of total billed charges,71% of total billed charges,185.44,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,80.42,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,219.6,90,,,percent of total billed charges,90% of total billed charges,219.6,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,216.18,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,78.08,32,,,percent of total billed charges,32% of total billed charges,195.2,80,,,percent of total billed charges,80% of total billed charges,195.2,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,222.04,91,,,percent of total billed charges,91% of total billed charges,79.64,32.64,,,percent of total billed charges,32.64% of total billed charges,78.08,32,,,percent of total billed charges,32% of total billed charges,81.98,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,78.08,32,,,percent of total billed charges,32% of total billed charges,78.08,32,,,percent of total billed charges,32% of total billed charges,224.48,92,,,percent of total billed charges,92% of total billed charges,20.71,224.48,
COVID19 RAPID TEST,2001822,CDM,306,RC,87635,HCPCS,Outpatient,,,244,207.4,,198.13,81.2,,,percent of total billed charges,81.2% of total billed charges,79.64,32.64,,,percent of total billed charges,32.64% of total billed charges,180.56,74,,,percent of total billed charges,74% of total billed charges,180.56,74,,,percent of total billed charges,74% of total billed charges,78.08,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,78.08,32,,,percent of total billed charges,32% of total billed charges,173.24,71,,,percent of total billed charges,71% of total billed charges,173.24,71,,,percent of total billed charges,71% of total billed charges,163.48,67,,,percent of total billed charges,67% of total billed charges,163.48,67,,,percent of total billed charges,67% of total billed charges,173.24,71,,,percent of total billed charges,71% of total billed charges,185.44,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,80.42,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,219.6,90,,,percent of total billed charges,90% of total billed charges,219.6,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,216.18,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,78.08,32,,,percent of total billed charges,32% of total billed charges,195.2,80,,,percent of total billed charges,80% of total billed charges,195.2,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,222.04,91,,,percent of total billed charges,91% of total billed charges,79.64,32.64,,,percent of total billed charges,32.64% of total billed charges,78.08,32,,,percent of total billed charges,32% of total billed charges,81.98,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,78.08,32,,,percent of total billed charges,32% of total billed charges,78.08,32,,,percent of total billed charges,32% of total billed charges,224.48,92,,,percent of total billed charges,92% of total billed charges,20.71,224.48,
STREP GROUP A PCR,2001851,CDM,300,RC,87651,HCPCS,Outpatient,,,110,93.5,,89.32,81.2,,,percent of total billed charges,81.2% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,81.4,74,,,percent of total billed charges,74% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,73.7,67,,,percent of total billed charges,67% of total billed charges,78.1,71,,,percent of total billed charges,71% of total billed charges,83.6,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,36.26,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,97.46,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,88,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,100.1,91,,,percent of total billed charges,91% of total billed charges,35.9,32.64,,,percent of total billed charges,32.64% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,36.96,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,35.2,32,,,percent of total billed charges,32% of total billed charges,35.2,32,,,percent of total billed charges,32% of total billed charges,101.2,92,,,percent of total billed charges,92% of total billed charges,20.71,101.2,
TRICHOMONAS VAGINALIS,2001455,CDM,306,RC,87661,HCPCS,Outpatient,,,76,64.6,,61.71,81.2,,,percent of total billed charges,81.2% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,56.24,74,,,percent of total billed charges,74% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,50.92,67,,,percent of total billed charges,67% of total billed charges,53.96,71,,,percent of total billed charges,71% of total billed charges,57.76,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,25.05,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,67.34,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,60.8,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,69.16,91,,,percent of total billed charges,91% of total billed charges,24.81,32.64,,,percent of total billed charges,32.64% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,25.54,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,24.32,32,,,percent of total billed charges,32% of total billed charges,24.32,32,,,percent of total billed charges,32% of total billed charges,69.92,92,,,percent of total billed charges,92% of total billed charges,20.71,69.92,
ATOPOBIUM VAGINAE,2001714,CDM,300,RC,87798,HCPCS,Outpatient,,,220,187,,178.64,81.2,,,percent of total billed charges,81.2% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,167.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.51,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,194.92,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,200.2,91,,,percent of total billed charges,91% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,73.92,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,202.4,92,,,percent of total billed charges,92% of total billed charges,20.71,202.4,
B PERTUSSIS AND B PARAPERTUSSIS PCR,2001190,CDM,306,RC,87798,HCPCS,Outpatient,,,220,187,,178.64,81.2,,,percent of total billed charges,81.2% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,167.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.51,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,194.92,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,200.2,91,,,percent of total billed charges,91% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,73.92,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,202.4,92,,,percent of total billed charges,92% of total billed charges,20.71,202.4,
BORDETELLA PERTUSIS  BY PCR,2000681,CDM,306,RC,87798,HCPCS,Outpatient,,,220,187,,178.64,81.2,,,percent of total billed charges,81.2% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,167.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.51,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,194.92,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,200.2,91,,,percent of total billed charges,91% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,73.92,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,202.4,92,,,percent of total billed charges,92% of total billed charges,20.71,202.4,
BVAB-2,2001715,CDM,300,RC,87798,HCPCS,Outpatient,,,220,187,,178.64,81.2,,,percent of total billed charges,81.2% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,167.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.51,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,194.92,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,200.2,91,,,percent of total billed charges,91% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,73.92,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,202.4,92,,,percent of total billed charges,92% of total billed charges,20.71,202.4,
JC VIRUS,2001318,CDM,306,RC,87798,HCPCS,Outpatient,,,220,187,,178.64,81.2,,,percent of total billed charges,81.2% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,167.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.51,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,194.92,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,200.2,91,,,percent of total billed charges,91% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,73.92,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,202.4,92,,,percent of total billed charges,92% of total billed charges,20.71,202.4,
MEGASPHAERA,2001716,CDM,300,RC,87798,HCPCS,Outpatient,,,220,187,,178.64,81.2,,,percent of total billed charges,81.2% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,167.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.51,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,194.92,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,200.2,91,,,percent of total billed charges,91% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,73.92,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,202.4,92,,,percent of total billed charges,92% of total billed charges,20.71,202.4,
VARICELLA ZOSTER VIRUS BY PCR,2000847,CDM,300,RC,87798,HCPCS,Outpatient,,,220,187,,178.64,81.2,,,percent of total billed charges,81.2% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,162.8,74,,,percent of total billed charges,74% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,147.4,67,,,percent of total billed charges,67% of total billed charges,156.2,71,,,percent of total billed charges,71% of total billed charges,167.2,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,72.51,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,194.92,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,176,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,200.2,91,,,percent of total billed charges,91% of total billed charges,71.81,32.64,,,percent of total billed charges,32.64% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,73.92,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,70.4,32,,,percent of total billed charges,32% of total billed charges,70.4,32,,,percent of total billed charges,32% of total billed charges,202.4,92,,,percent of total billed charges,92% of total billed charges,20.71,202.4,
BK Virus BY PCR,2001034,CDM,300,RC,87799,HCPCS,Outpatient,,,517,439.45,,419.8,81.2,,,percent of total billed charges,81.2% of total billed charges,168.75,32.64,,,percent of total billed charges,32.64% of total billed charges,382.58,74,,,percent of total billed charges,74% of total billed charges,382.58,74,,,percent of total billed charges,74% of total billed charges,165.44,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,165.44,32,,,percent of total billed charges,32% of total billed charges,367.07,71,,,percent of total billed charges,71% of total billed charges,367.07,71,,,percent of total billed charges,71% of total billed charges,346.39,67,,,percent of total billed charges,67% of total billed charges,346.39,67,,,percent of total billed charges,67% of total billed charges,367.07,71,,,percent of total billed charges,71% of total billed charges,392.92,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,170.4,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,465.3,90,,,percent of total billed charges,90% of total billed charges,465.3,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,458.06,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,165.44,32,,,percent of total billed charges,32% of total billed charges,413.6,80,,,percent of total billed charges,80% of total billed charges,413.6,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,470.47,91,,,percent of total billed charges,91% of total billed charges,168.75,32.64,,,percent of total billed charges,32.64% of total billed charges,165.44,32,,,percent of total billed charges,32% of total billed charges,173.71,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,165.44,32,,,percent of total billed charges,32% of total billed charges,165.44,32,,,percent of total billed charges,32% of total billed charges,475.64,92,,,percent of total billed charges,92% of total billed charges,20.71,475.64,
EPSTEIN BARR QUANT BY PCR,2001030,CDM,300,RC,87799,HCPCS,Outpatient,,,517,439.45,,419.8,81.2,,,percent of total billed charges,81.2% of total billed charges,168.75,32.64,,,percent of total billed charges,32.64% of total billed charges,382.58,74,,,percent of total billed charges,74% of total billed charges,382.58,74,,,percent of total billed charges,74% of total billed charges,165.44,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,165.44,32,,,percent of total billed charges,32% of total billed charges,367.07,71,,,percent of total billed charges,71% of total billed charges,367.07,71,,,percent of total billed charges,71% of total billed charges,346.39,67,,,percent of total billed charges,67% of total billed charges,346.39,67,,,percent of total billed charges,67% of total billed charges,367.07,71,,,percent of total billed charges,71% of total billed charges,392.92,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,170.4,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,465.3,90,,,percent of total billed charges,90% of total billed charges,465.3,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,458.06,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,165.44,32,,,percent of total billed charges,32% of total billed charges,413.6,80,,,percent of total billed charges,80% of total billed charges,413.6,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,470.47,91,,,percent of total billed charges,91% of total billed charges,168.75,32.64,,,percent of total billed charges,32.64% of total billed charges,165.44,32,,,percent of total billed charges,32% of total billed charges,173.71,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,165.44,32,,,percent of total billed charges,32% of total billed charges,165.44,32,,,percent of total billed charges,32% of total billed charges,475.64,92,,,percent of total billed charges,92% of total billed charges,20.71,475.64,
"C ALBICANS + C GLABRATA, NAA",2001713,CDM,300,RC,87801,HCPCS,Outpatient,,,286,243.1,,232.23,81.2,,,percent of total billed charges,81.2% of total billed charges,93.35,32.64,,,percent of total billed charges,32.64% of total billed charges,211.64,74,,,percent of total billed charges,74% of total billed charges,211.64,74,,,percent of total billed charges,74% of total billed charges,91.52,32,,,percent of total billed charges,32% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,91.52,32,,,percent of total billed charges,32% of total billed charges,203.06,71,,,percent of total billed charges,71% of total billed charges,203.06,71,,,percent of total billed charges,71% of total billed charges,191.62,67,,,percent of total billed charges,67% of total billed charges,191.62,67,,,percent of total billed charges,67% of total billed charges,203.06,71,,,percent of total billed charges,71% of total billed charges,217.36,76,,,percent of total billed charges,76% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,94.27,32.96,,,percent of total billed charges,32.96% of total billed charges,21.75,105,,,Fee Schedule,pays based on EAPG rates,257.4,90,,,percent of total billed charges,90% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,253.4,88.6,,,percent of total billed charges,88.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,91.52,32,,,percent of total billed charges,32% of total billed charges,228.8,80,,,percent of total billed charges,80% of total billed charges,228.8,80,,,percent of total billed charges,80% of total billed charges,20.71,100,,,Fee Schedule,pays based on EAPG rates,260.26,91,,,percent of total billed charges,91% of total billed charges,93.35,32.64,,,percent of total billed charges,32.64% of total billed charges,91.52,32,,,percent of total billed charges,32% of total billed charges,96.1,33.6,,,percent of total billed charges,33.6% of total billed charges,21.33,103,,,Fee Schedule,pays based on EAPG rates,91.52,32,,,percent of total billed charges,32% of total billed charges,91.52,32,,,percent of total billed charges,32% of total billed charges,263.12,92,,,percent of total billed charges,92% of total billed charges,20.71,263.12,
STREP PNEUMO ANTIGE,2001089,CDM,306,RC,87802,HCPCS,Outpatient,,,23,19.55,,18.68,81.2,,,percent of total billed charges,81.2% of total billed charges,7.51,32.64,,,percent of total billed charges,32.64% of total billed charges,17.02,74,,,percent of total billed charges,74% of total billed charges,17.02,74,,,percent of total billed charges,74% of total billed charges,7.36,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.36,32,,,percent of total billed charges,32% of total billed charges,16.33,71,,,percent of total billed charges,71% of total billed charges,16.33,71,,,percent of total billed charges,71% of total billed charges,15.41,67,,,percent of total billed charges,67% of total billed charges,15.41,67,,,percent of total billed charges,67% of total billed charges,16.33,71,,,percent of total billed charges,71% of total billed charges,17.48,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.58,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,20.7,90,,,percent of total billed charges,90% of total billed charges,20.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,20.38,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.36,32,,,percent of total billed charges,32% of total billed charges,18.4,80,,,percent of total billed charges,80% of total billed charges,18.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,20.93,91,,,percent of total billed charges,91% of total billed charges,7.51,32.64,,,percent of total billed charges,32.64% of total billed charges,7.36,32,,,percent of total billed charges,32% of total billed charges,7.73,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.36,32,,,percent of total billed charges,32% of total billed charges,7.36,32,,,percent of total billed charges,32% of total billed charges,21.16,92,,,percent of total billed charges,92% of total billed charges,7.36,21.16,
C DIFFICILE TOXIN A/B,2000174,CDM,306,RC,87803,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,10.25,70.84,
QUICK VUE SARS ANTIGEN,2001852,CDM,306,RC,87811,HCPCS,Outpatient,,,164,139.4,,133.17,81.2,,,percent of total billed charges,81.2% of total billed charges,53.53,32.64,,,percent of total billed charges,32.64% of total billed charges,121.36,74,,,percent of total billed charges,74% of total billed charges,121.36,74,,,percent of total billed charges,74% of total billed charges,52.48,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,52.48,32,,,percent of total billed charges,32% of total billed charges,116.44,71,,,percent of total billed charges,71% of total billed charges,116.44,71,,,percent of total billed charges,71% of total billed charges,109.88,67,,,percent of total billed charges,67% of total billed charges,109.88,67,,,percent of total billed charges,67% of total billed charges,116.44,71,,,percent of total billed charges,71% of total billed charges,124.64,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,54.05,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,147.6,90,,,percent of total billed charges,90% of total billed charges,147.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,145.3,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,52.48,32,,,percent of total billed charges,32% of total billed charges,131.2,80,,,percent of total billed charges,80% of total billed charges,131.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,149.24,91,,,percent of total billed charges,91% of total billed charges,53.53,32.64,,,percent of total billed charges,32.64% of total billed charges,52.48,32,,,percent of total billed charges,32% of total billed charges,55.1,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,52.48,32,,,percent of total billed charges,32% of total billed charges,52.48,32,,,percent of total billed charges,32% of total billed charges,150.88,92,,,percent of total billed charges,92% of total billed charges,52.48,150.88,
BACTERIA ANTIGEN TYPING,2001090,CDM,306,RC,87899,HCPCS,Outpatient,,,23,19.55,,18.68,81.2,,,percent of total billed charges,81.2% of total billed charges,7.51,32.64,,,percent of total billed charges,32.64% of total billed charges,17.02,74,,,percent of total billed charges,74% of total billed charges,17.02,74,,,percent of total billed charges,74% of total billed charges,7.36,32,,,percent of total billed charges,32% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.36,32,,,percent of total billed charges,32% of total billed charges,16.33,71,,,percent of total billed charges,71% of total billed charges,16.33,71,,,percent of total billed charges,71% of total billed charges,15.41,67,,,percent of total billed charges,67% of total billed charges,15.41,67,,,percent of total billed charges,67% of total billed charges,16.33,71,,,percent of total billed charges,71% of total billed charges,17.48,76,,,percent of total billed charges,76% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.58,32.96,,,percent of total billed charges,32.96% of total billed charges,10.76,105,,,Fee Schedule,pays based on EAPG rates,20.7,90,,,percent of total billed charges,90% of total billed charges,20.7,90,,,percent of total billed charges,90% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,20.38,88.6,,,percent of total billed charges,88.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.36,32,,,percent of total billed charges,32% of total billed charges,18.4,80,,,percent of total billed charges,80% of total billed charges,18.4,80,,,percent of total billed charges,80% of total billed charges,10.25,100,,,Fee Schedule,pays based on EAPG rates,20.93,91,,,percent of total billed charges,91% of total billed charges,7.51,32.64,,,percent of total billed charges,32.64% of total billed charges,7.36,32,,,percent of total billed charges,32% of total billed charges,7.73,33.6,,,percent of total billed charges,33.6% of total billed charges,10.56,103,,,Fee Schedule,pays based on EAPG rates,7.36,32,,,percent of total billed charges,32% of total billed charges,7.36,32,,,percent of total billed charges,32% of total billed charges,21.16,92,,,percent of total billed charges,92% of total billed charges,7.36,21.16,
HEPATITIS C GENOTYPING,2000743,CDM,300,RC,87902,HCPCS,Outpatient,,,651,553.35,,528.61,81.2,,,percent of total billed charges,81.2% of total billed charges,212.49,32.64,,,percent of total billed charges,32.64% of total billed charges,481.74,74,,,percent of total billed charges,74% of total billed charges,481.74,74,,,percent of total billed charges,74% of total billed charges,208.32,32,,,percent of total billed charges,32% of total billed charges,31.18,103,,,Fee Schedule,pays based on EAPG rates,208.32,32,,,percent of total billed charges,32% of total billed charges,462.21,71,,,percent of total billed charges,71% of total billed charges,462.21,71,,,percent of total billed charges,71% of total billed charges,436.17,67,,,percent of total billed charges,67% of total billed charges,436.17,67,,,percent of total billed charges,67% of total billed charges,462.21,71,,,percent of total billed charges,71% of total billed charges,494.76,76,,,percent of total billed charges,76% of total billed charges,31.18,103,,,Fee Schedule,pays based on EAPG rates,214.57,32.96,,,percent of total billed charges,32.96% of total billed charges,31.79,105,,,Fee Schedule,pays based on EAPG rates,585.9,90,,,percent of total billed charges,90% of total billed charges,585.9,90,,,percent of total billed charges,90% of total billed charges,30.27,100,,,Fee Schedule,pays based on EAPG rates,576.79,88.6,,,percent of total billed charges,88.6% of total billed charges,31.18,103,,,Fee Schedule,pays based on EAPG rates,208.32,32,,,percent of total billed charges,32% of total billed charges,520.8,80,,,percent of total billed charges,80% of total billed charges,520.8,80,,,percent of total billed charges,80% of total billed charges,30.27,100,,,Fee Schedule,pays based on EAPG rates,592.41,91,,,percent of total billed charges,91% of total billed charges,212.49,32.64,,,percent of total billed charges,32.64% of total billed charges,208.32,32,,,percent of total billed charges,32% of total billed charges,218.74,33.6,,,percent of total billed charges,33.6% of total billed charges,31.18,103,,,Fee Schedule,pays based on EAPG rates,208.32,32,,,percent of total billed charges,32% of total billed charges,208.32,32,,,percent of total billed charges,32% of total billed charges,598.92,92,,,percent of total billed charges,92% of total billed charges,30.27,598.92,
CYTOPATH FLUID OR WASH,2000379,CDM,311,RC,88108,HCPCS,Outpatient,,,185,157.25,,150.22,81.2,,,percent of total billed charges,81.2% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,140.6,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,60.98,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,163.91,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,168.35,91,,,percent of total billed charges,91% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,62.16,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,170.2,92,,,percent of total billed charges,92% of total billed charges,5.52,170.2,
THIN PREP NON GYN,2000797,CDM,300,RC,88112,HCPCS,Outpatient,,,242,205.7,,196.5,81.2,,,percent of total billed charges,81.2% of total billed charges,78.99,32.64,,,percent of total billed charges,32.64% of total billed charges,179.08,74,,,percent of total billed charges,74% of total billed charges,179.08,74,,,percent of total billed charges,74% of total billed charges,77.44,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,77.44,32,,,percent of total billed charges,32% of total billed charges,171.82,71,,,percent of total billed charges,71% of total billed charges,171.82,71,,,percent of total billed charges,71% of total billed charges,162.14,67,,,percent of total billed charges,67% of total billed charges,162.14,67,,,percent of total billed charges,67% of total billed charges,171.82,71,,,percent of total billed charges,71% of total billed charges,183.92,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,79.76,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,217.8,90,,,percent of total billed charges,90% of total billed charges,217.8,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,214.41,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,77.44,32,,,percent of total billed charges,32% of total billed charges,193.6,80,,,percent of total billed charges,80% of total billed charges,193.6,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,220.22,91,,,percent of total billed charges,91% of total billed charges,78.99,32.64,,,percent of total billed charges,32.64% of total billed charges,77.44,32,,,percent of total billed charges,32% of total billed charges,81.31,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,77.44,32,,,percent of total billed charges,32% of total billed charges,77.44,32,,,percent of total billed charges,32% of total billed charges,222.64,92,,,percent of total billed charges,92% of total billed charges,28.01,222.64,
THIN PREP PAP,2000602,CDM,311,RC,88142,HCPCS,Outpatient,,,139,118.15,,112.87,81.2,,,percent of total billed charges,81.2% of total billed charges,45.37,32.64,,,percent of total billed charges,32.64% of total billed charges,102.86,74,,,percent of total billed charges,74% of total billed charges,102.86,74,,,percent of total billed charges,74% of total billed charges,44.48,32,,,percent of total billed charges,32% of total billed charges,9.69,103,,,Fee Schedule,pays based on EAPG rates,44.48,32,,,percent of total billed charges,32% of total billed charges,98.69,71,,,percent of total billed charges,71% of total billed charges,98.69,71,,,percent of total billed charges,71% of total billed charges,93.13,67,,,percent of total billed charges,67% of total billed charges,93.13,67,,,percent of total billed charges,67% of total billed charges,98.69,71,,,percent of total billed charges,71% of total billed charges,105.64,76,,,percent of total billed charges,76% of total billed charges,9.69,103,,,Fee Schedule,pays based on EAPG rates,45.81,32.96,,,percent of total billed charges,32.96% of total billed charges,9.88,105,,,Fee Schedule,pays based on EAPG rates,125.1,90,,,percent of total billed charges,90% of total billed charges,125.1,90,,,percent of total billed charges,90% of total billed charges,9.41,100,,,Fee Schedule,pays based on EAPG rates,123.15,88.6,,,percent of total billed charges,88.6% of total billed charges,9.69,103,,,Fee Schedule,pays based on EAPG rates,44.48,32,,,percent of total billed charges,32% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,111.2,80,,,percent of total billed charges,80% of total billed charges,9.41,100,,,Fee Schedule,pays based on EAPG rates,126.49,91,,,percent of total billed charges,91% of total billed charges,45.37,32.64,,,percent of total billed charges,32.64% of total billed charges,44.48,32,,,percent of total billed charges,32% of total billed charges,46.7,33.6,,,percent of total billed charges,33.6% of total billed charges,9.69,103,,,Fee Schedule,pays based on EAPG rates,44.48,32,,,percent of total billed charges,32% of total billed charges,44.48,32,,,percent of total billed charges,32% of total billed charges,127.88,92,,,percent of total billed charges,92% of total billed charges,9.41,127.88,
CYTOPATH OTHER SOURCE PREP,2000383,CDM,311,RC,88161,HCPCS,Outpatient,,,141,119.85,,114.49,81.2,,,percent of total billed charges,81.2% of total billed charges,46.02,32.64,,,percent of total billed charges,32.64% of total billed charges,104.34,74,,,percent of total billed charges,74% of total billed charges,104.34,74,,,percent of total billed charges,74% of total billed charges,45.12,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,45.12,32,,,percent of total billed charges,32% of total billed charges,100.11,71,,,percent of total billed charges,71% of total billed charges,100.11,71,,,percent of total billed charges,71% of total billed charges,94.47,67,,,percent of total billed charges,67% of total billed charges,94.47,67,,,percent of total billed charges,67% of total billed charges,100.11,71,,,percent of total billed charges,71% of total billed charges,107.16,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,46.47,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,126.9,90,,,percent of total billed charges,90% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,124.93,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,45.12,32,,,percent of total billed charges,32% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,112.8,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,128.31,91,,,percent of total billed charges,91% of total billed charges,46.02,32.64,,,percent of total billed charges,32.64% of total billed charges,45.12,32,,,percent of total billed charges,32% of total billed charges,47.38,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,45.12,32,,,percent of total billed charges,32% of total billed charges,45.12,32,,,percent of total billed charges,32% of total billed charges,129.72,92,,,percent of total billed charges,92% of total billed charges,5.52,129.72,
FLOW CYTOMETRY 1ST MARKER,2001820,CDM,311,RC,88184,HCPCS,Outpatient,,,1227,1042.95,,996.32,81.2,,,percent of total billed charges,81.2% of total billed charges,400.49,32.64,,,percent of total billed charges,32.64% of total billed charges,907.98,74,,,percent of total billed charges,74% of total billed charges,907.98,74,,,percent of total billed charges,74% of total billed charges,392.64,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,392.64,32,,,percent of total billed charges,32% of total billed charges,871.17,71,,,percent of total billed charges,71% of total billed charges,871.17,71,,,percent of total billed charges,71% of total billed charges,822.09,67,,,percent of total billed charges,67% of total billed charges,822.09,67,,,percent of total billed charges,67% of total billed charges,871.17,71,,,percent of total billed charges,71% of total billed charges,932.52,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,404.42,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,1104.3,90,,,percent of total billed charges,90% of total billed charges,1104.3,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,1087.12,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,392.64,32,,,percent of total billed charges,32% of total billed charges,981.6,80,,,percent of total billed charges,80% of total billed charges,981.6,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,1116.57,91,,,percent of total billed charges,91% of total billed charges,400.49,32.64,,,percent of total billed charges,32.64% of total billed charges,392.64,32,,,percent of total billed charges,32% of total billed charges,412.27,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,392.64,32,,,percent of total billed charges,32% of total billed charges,392.64,32,,,percent of total billed charges,32% of total billed charges,1128.84,92,,,percent of total billed charges,92% of total billed charges,28.01,1128.84,
FLOW CYTOMETRY EA ADD MARKER,2001821,CDM,311,RC,88185,HCPCS,Outpatient,,,2325,1976.25,,1887.9,81.2,,,percent of total billed charges,81.2% of total billed charges,758.88,32.64,,,percent of total billed charges,32.64% of total billed charges,1720.5,74,,,percent of total billed charges,74% of total billed charges,1720.5,74,,,percent of total billed charges,74% of total billed charges,744,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,744,32,,,percent of total billed charges,32% of total billed charges,1650.75,71,,,percent of total billed charges,71% of total billed charges,1650.75,71,,,percent of total billed charges,71% of total billed charges,1557.75,67,,,percent of total billed charges,67% of total billed charges,1557.75,67,,,percent of total billed charges,67% of total billed charges,1650.75,71,,,percent of total billed charges,71% of total billed charges,1767,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,766.32,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,2092.5,90,,,percent of total billed charges,90% of total billed charges,2092.5,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,2059.95,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,744,32,,,percent of total billed charges,32% of total billed charges,1860,80,,,percent of total billed charges,80% of total billed charges,1860,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,2115.75,91,,,percent of total billed charges,91% of total billed charges,758.88,32.64,,,percent of total billed charges,32.64% of total billed charges,744,32,,,percent of total billed charges,32% of total billed charges,781.2,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,744,32,,,percent of total billed charges,32% of total billed charges,744,32,,,percent of total billed charges,32% of total billed charges,2139,92,,,percent of total billed charges,92% of total billed charges,37.42,2139,
INTERP (2-8 MARKERS),2001846,CDM,310,RC,88187,HCPCS,Outpatient,,,1155,981.75,,937.86,81.2,,,percent of total billed charges,81.2% of total billed charges,376.99,32.64,,,percent of total billed charges,32.64% of total billed charges,854.7,74,,,percent of total billed charges,74% of total billed charges,854.7,74,,,percent of total billed charges,74% of total billed charges,369.6,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,369.6,32,,,percent of total billed charges,32% of total billed charges,820.05,71,,,percent of total billed charges,71% of total billed charges,820.05,71,,,percent of total billed charges,71% of total billed charges,773.85,67,,,percent of total billed charges,67% of total billed charges,773.85,67,,,percent of total billed charges,67% of total billed charges,820.05,71,,,percent of total billed charges,71% of total billed charges,877.8,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,380.69,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,1039.5,90,,,percent of total billed charges,90% of total billed charges,1039.5,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,1023.33,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,369.6,32,,,percent of total billed charges,32% of total billed charges,924,80,,,percent of total billed charges,80% of total billed charges,924,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,1051.05,91,,,percent of total billed charges,91% of total billed charges,376.99,32.64,,,percent of total billed charges,32.64% of total billed charges,369.6,32,,,percent of total billed charges,32% of total billed charges,388.08,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,369.6,32,,,percent of total billed charges,32% of total billed charges,369.6,32,,,percent of total billed charges,32% of total billed charges,1062.6,92,,,percent of total billed charges,92% of total billed charges,5.52,1062.6,
FLOW CYTOMETRY INTERPRET 9 15 MARKERS,2000890,CDM,300,RC,88188,HCPCS,Outpatient,,,70,59.5,,56.84,81.2,,,percent of total billed charges,81.2% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,51.8,74,,,percent of total billed charges,74% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,46.9,67,,,percent of total billed charges,67% of total billed charges,49.7,71,,,percent of total billed charges,71% of total billed charges,53.2,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,23.07,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,62.02,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,56,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,63.7,91,,,percent of total billed charges,91% of total billed charges,22.85,32.64,,,percent of total billed charges,32.64% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,23.52,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,22.4,32,,,percent of total billed charges,32% of total billed charges,22.4,32,,,percent of total billed charges,32% of total billed charges,64.4,92,,,percent of total billed charges,92% of total billed charges,5.52,64.4,
INTERP (16+ MARKERS),2001849,CDM,310,RC,88189,HCPCS,Outpatient,,,1043,886.55,,846.92,81.2,,,percent of total billed charges,81.2% of total billed charges,340.44,32.64,,,percent of total billed charges,32.64% of total billed charges,771.82,74,,,percent of total billed charges,74% of total billed charges,771.82,74,,,percent of total billed charges,74% of total billed charges,333.76,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,333.76,32,,,percent of total billed charges,32% of total billed charges,740.53,71,,,percent of total billed charges,71% of total billed charges,740.53,71,,,percent of total billed charges,71% of total billed charges,698.81,67,,,percent of total billed charges,67% of total billed charges,698.81,67,,,percent of total billed charges,67% of total billed charges,740.53,71,,,percent of total billed charges,71% of total billed charges,792.68,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,343.77,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,938.7,90,,,percent of total billed charges,90% of total billed charges,938.7,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,924.1,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,333.76,32,,,percent of total billed charges,32% of total billed charges,834.4,80,,,percent of total billed charges,80% of total billed charges,834.4,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,949.13,91,,,percent of total billed charges,91% of total billed charges,340.44,32.64,,,percent of total billed charges,32.64% of total billed charges,333.76,32,,,percent of total billed charges,32% of total billed charges,350.45,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,333.76,32,,,percent of total billed charges,32% of total billed charges,333.76,32,,,percent of total billed charges,32% of total billed charges,959.56,92,,,percent of total billed charges,92% of total billed charges,5.52,959.56,
FISH BID LYMPH CULTURE,2000918,CDM,300,RC,88230,HCPCS,Outpatient,,,418,355.3,,339.42,81.2,,,percent of total billed charges,81.2% of total billed charges,136.44,32.64,,,percent of total billed charges,32.64% of total billed charges,309.32,74,,,percent of total billed charges,74% of total billed charges,309.32,74,,,percent of total billed charges,74% of total billed charges,133.76,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,133.76,32,,,percent of total billed charges,32% of total billed charges,296.78,71,,,percent of total billed charges,71% of total billed charges,296.78,71,,,percent of total billed charges,71% of total billed charges,280.06,67,,,percent of total billed charges,67% of total billed charges,280.06,67,,,percent of total billed charges,67% of total billed charges,296.78,71,,,percent of total billed charges,71% of total billed charges,317.68,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,137.77,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,376.2,90,,,percent of total billed charges,90% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,370.35,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,133.76,32,,,percent of total billed charges,32% of total billed charges,334.4,80,,,percent of total billed charges,80% of total billed charges,334.4,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,380.38,91,,,percent of total billed charges,91% of total billed charges,136.44,32.64,,,percent of total billed charges,32.64% of total billed charges,133.76,32,,,percent of total billed charges,32% of total billed charges,140.45,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,133.76,32,,,percent of total billed charges,32% of total billed charges,133.76,32,,,percent of total billed charges,32% of total billed charges,384.56,92,,,percent of total billed charges,92% of total billed charges,37.42,384.56,
FRAGILE X DNA SCREEN (PRENATAL),2099022,CDM,300,RC,88235,HCPCS,Outpatient,,,301,255.85,,244.41,81.2,,,percent of total billed charges,81.2% of total billed charges,98.25,32.64,,,percent of total billed charges,32.64% of total billed charges,222.74,74,,,percent of total billed charges,74% of total billed charges,222.74,74,,,percent of total billed charges,74% of total billed charges,96.32,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,96.32,32,,,percent of total billed charges,32% of total billed charges,213.71,71,,,percent of total billed charges,71% of total billed charges,213.71,71,,,percent of total billed charges,71% of total billed charges,201.67,67,,,percent of total billed charges,67% of total billed charges,201.67,67,,,percent of total billed charges,67% of total billed charges,213.71,71,,,percent of total billed charges,71% of total billed charges,228.76,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,99.21,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,270.9,90,,,percent of total billed charges,90% of total billed charges,270.9,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,266.69,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,96.32,32,,,percent of total billed charges,32% of total billed charges,240.8,80,,,percent of total billed charges,80% of total billed charges,240.8,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,273.91,91,,,percent of total billed charges,91% of total billed charges,98.25,32.64,,,percent of total billed charges,32.64% of total billed charges,96.32,32,,,percent of total billed charges,32% of total billed charges,101.14,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,96.32,32,,,percent of total billed charges,32% of total billed charges,96.32,32,,,percent of total billed charges,32% of total billed charges,276.92,92,,,percent of total billed charges,92% of total billed charges,37.42,276.92,
OSU HC TISSUE CULTURE BM BLOOD CELLS,2001837,CDM,310,RC,88237,HCPCS,Outpatient,,,774,657.9,,628.49,81.2,,,percent of total billed charges,81.2% of total billed charges,252.63,32.64,,,percent of total billed charges,32.64% of total billed charges,572.76,74,,,percent of total billed charges,74% of total billed charges,572.76,74,,,percent of total billed charges,74% of total billed charges,247.68,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,247.68,32,,,percent of total billed charges,32% of total billed charges,549.54,71,,,percent of total billed charges,71% of total billed charges,549.54,71,,,percent of total billed charges,71% of total billed charges,518.58,67,,,percent of total billed charges,67% of total billed charges,518.58,67,,,percent of total billed charges,67% of total billed charges,549.54,71,,,percent of total billed charges,71% of total billed charges,588.24,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,255.11,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,696.6,90,,,percent of total billed charges,90% of total billed charges,696.6,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,685.76,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,247.68,32,,,percent of total billed charges,32% of total billed charges,619.2,80,,,percent of total billed charges,80% of total billed charges,619.2,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,704.34,91,,,percent of total billed charges,91% of total billed charges,252.63,32.64,,,percent of total billed charges,32.64% of total billed charges,247.68,32,,,percent of total billed charges,32% of total billed charges,260.06,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,247.68,32,,,percent of total billed charges,32% of total billed charges,247.68,32,,,percent of total billed charges,32% of total billed charges,712.08,92,,,percent of total billed charges,92% of total billed charges,37.42,712.08,
LAB CORP CHROM ANLYS 5 CELLS,2001862,CDM,310,RC,88261,HCPCS,Outpatient,,,737,626.45,,598.44,81.2,,,percent of total billed charges,81.2% of total billed charges,240.56,32.64,,,percent of total billed charges,32.64% of total billed charges,545.38,74,,,percent of total billed charges,74% of total billed charges,545.38,74,,,percent of total billed charges,74% of total billed charges,235.84,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,235.84,32,,,percent of total billed charges,32% of total billed charges,523.27,71,,,percent of total billed charges,71% of total billed charges,523.27,71,,,percent of total billed charges,71% of total billed charges,493.79,67,,,percent of total billed charges,67% of total billed charges,493.79,67,,,percent of total billed charges,67% of total billed charges,523.27,71,,,percent of total billed charges,71% of total billed charges,560.12,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,242.92,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,663.3,90,,,percent of total billed charges,90% of total billed charges,663.3,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,652.98,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,235.84,32,,,percent of total billed charges,32% of total billed charges,589.6,80,,,percent of total billed charges,80% of total billed charges,589.6,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,670.67,91,,,percent of total billed charges,91% of total billed charges,240.56,32.64,,,percent of total billed charges,32.64% of total billed charges,235.84,32,,,percent of total billed charges,32% of total billed charges,247.63,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,235.84,32,,,percent of total billed charges,32% of total billed charges,235.84,32,,,percent of total billed charges,32% of total billed charges,678.04,92,,,percent of total billed charges,92% of total billed charges,71.76,678.04,
FISH BID CHROMOSONE ANALYSIS,2000919,CDM,300,RC,88262,HCPCS,Outpatient,,,491,417.35,,398.69,81.2,,,percent of total billed charges,81.2% of total billed charges,160.26,32.64,,,percent of total billed charges,32.64% of total billed charges,363.34,74,,,percent of total billed charges,74% of total billed charges,363.34,74,,,percent of total billed charges,74% of total billed charges,157.12,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,157.12,32,,,percent of total billed charges,32% of total billed charges,348.61,71,,,percent of total billed charges,71% of total billed charges,348.61,71,,,percent of total billed charges,71% of total billed charges,328.97,67,,,percent of total billed charges,67% of total billed charges,328.97,67,,,percent of total billed charges,67% of total billed charges,348.61,71,,,percent of total billed charges,71% of total billed charges,373.16,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,161.83,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,441.9,90,,,percent of total billed charges,90% of total billed charges,441.9,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,435.03,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,157.12,32,,,percent of total billed charges,32% of total billed charges,392.8,80,,,percent of total billed charges,80% of total billed charges,392.8,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,446.81,91,,,percent of total billed charges,91% of total billed charges,160.26,32.64,,,percent of total billed charges,32.64% of total billed charges,157.12,32,,,percent of total billed charges,32% of total billed charges,164.98,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,157.12,32,,,percent of total billed charges,32% of total billed charges,157.12,32,,,percent of total billed charges,32% of total billed charges,451.72,92,,,percent of total billed charges,92% of total billed charges,71.76,451.72,
OSU HC CHROME ANALYSIS 20-25 CELLS,2001839,CDM,310,RC,88264,HCPCS,Outpatient,,,1564,1329.4,,1269.97,81.2,,,percent of total billed charges,81.2% of total billed charges,510.49,32.64,,,percent of total billed charges,32.64% of total billed charges,1157.36,74,,,percent of total billed charges,74% of total billed charges,1157.36,74,,,percent of total billed charges,74% of total billed charges,500.48,32,,,percent of total billed charges,32% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,500.48,32,,,percent of total billed charges,32% of total billed charges,1110.44,71,,,percent of total billed charges,71% of total billed charges,1110.44,71,,,percent of total billed charges,71% of total billed charges,1047.88,67,,,percent of total billed charges,67% of total billed charges,1047.88,67,,,percent of total billed charges,67% of total billed charges,1110.44,71,,,percent of total billed charges,71% of total billed charges,1188.64,76,,,percent of total billed charges,76% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,515.49,32.96,,,percent of total billed charges,32.96% of total billed charges,75.35,105,,,Fee Schedule,pays based on EAPG rates,1407.6,90,,,percent of total billed charges,90% of total billed charges,1407.6,90,,,percent of total billed charges,90% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,1385.7,88.6,,,percent of total billed charges,88.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,500.48,32,,,percent of total billed charges,32% of total billed charges,1251.2,80,,,percent of total billed charges,80% of total billed charges,1251.2,80,,,percent of total billed charges,80% of total billed charges,71.76,100,,,Fee Schedule,pays based on EAPG rates,1423.24,91,,,percent of total billed charges,91% of total billed charges,510.49,32.64,,,percent of total billed charges,32.64% of total billed charges,500.48,32,,,percent of total billed charges,32% of total billed charges,525.5,33.6,,,percent of total billed charges,33.6% of total billed charges,73.91,103,,,Fee Schedule,pays based on EAPG rates,500.48,32,,,percent of total billed charges,32% of total billed charges,500.48,32,,,percent of total billed charges,32% of total billed charges,1438.88,92,,,percent of total billed charges,92% of total billed charges,71.76,1438.88,
FISH DNA PROBE,2000917,CDM,300,RC,88271,HCPCS,Outpatient,,,332,282.2,,269.58,81.2,,,percent of total billed charges,81.2% of total billed charges,108.36,32.64,,,percent of total billed charges,32.64% of total billed charges,245.68,74,,,percent of total billed charges,74% of total billed charges,245.68,74,,,percent of total billed charges,74% of total billed charges,106.24,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,106.24,32,,,percent of total billed charges,32% of total billed charges,235.72,71,,,percent of total billed charges,71% of total billed charges,235.72,71,,,percent of total billed charges,71% of total billed charges,222.44,67,,,percent of total billed charges,67% of total billed charges,222.44,67,,,percent of total billed charges,67% of total billed charges,235.72,71,,,percent of total billed charges,71% of total billed charges,252.32,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,109.43,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,298.8,90,,,percent of total billed charges,90% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,294.15,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,106.24,32,,,percent of total billed charges,32% of total billed charges,265.6,80,,,percent of total billed charges,80% of total billed charges,265.6,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,302.12,91,,,percent of total billed charges,91% of total billed charges,108.36,32.64,,,percent of total billed charges,32.64% of total billed charges,106.24,32,,,percent of total billed charges,32% of total billed charges,111.55,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,106.24,32,,,percent of total billed charges,32% of total billed charges,106.24,32,,,percent of total billed charges,32% of total billed charges,305.44,92,,,percent of total billed charges,92% of total billed charges,51.71,305.44,
FISH TIS INSITU HYBRID 10 30,2000916,CDM,300,RC,88273,HCPCS,Outpatient,,,200,170,,162.4,81.2,,,percent of total billed charges,81.2% of total billed charges,65.28,32.64,,,percent of total billed charges,32.64% of total billed charges,148,74,,,percent of total billed charges,74% of total billed charges,148,74,,,percent of total billed charges,74% of total billed charges,64,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,64,32,,,percent of total billed charges,32% of total billed charges,142,71,,,percent of total billed charges,71% of total billed charges,142,71,,,percent of total billed charges,71% of total billed charges,134,67,,,percent of total billed charges,67% of total billed charges,134,67,,,percent of total billed charges,67% of total billed charges,142,71,,,percent of total billed charges,71% of total billed charges,152,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,65.92,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,177.2,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,64,32,,,percent of total billed charges,32% of total billed charges,160,80,,,percent of total billed charges,80% of total billed charges,160,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,182,91,,,percent of total billed charges,91% of total billed charges,65.28,32.64,,,percent of total billed charges,32.64% of total billed charges,64,32,,,percent of total billed charges,32% of total billed charges,67.2,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,64,32,,,percent of total billed charges,32% of total billed charges,64,32,,,percent of total billed charges,32% of total billed charges,184,92,,,percent of total billed charges,92% of total billed charges,51.71,184,
OSU HC MCG IP SITU 25-99 CELLS,2001838,CDM,310,RC,88274,HCPCS,Outpatient,,,608,516.8,,493.7,81.2,,,percent of total billed charges,81.2% of total billed charges,198.45,32.64,,,percent of total billed charges,32.64% of total billed charges,449.92,74,,,percent of total billed charges,74% of total billed charges,449.92,74,,,percent of total billed charges,74% of total billed charges,194.56,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,194.56,32,,,percent of total billed charges,32% of total billed charges,431.68,71,,,percent of total billed charges,71% of total billed charges,431.68,71,,,percent of total billed charges,71% of total billed charges,407.36,67,,,percent of total billed charges,67% of total billed charges,407.36,67,,,percent of total billed charges,67% of total billed charges,431.68,71,,,percent of total billed charges,71% of total billed charges,462.08,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,200.4,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,547.2,90,,,percent of total billed charges,90% of total billed charges,547.2,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,538.69,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,194.56,32,,,percent of total billed charges,32% of total billed charges,486.4,80,,,percent of total billed charges,80% of total billed charges,486.4,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,553.28,91,,,percent of total billed charges,91% of total billed charges,198.45,32.64,,,percent of total billed charges,32.64% of total billed charges,194.56,32,,,percent of total billed charges,32% of total billed charges,204.29,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,194.56,32,,,percent of total billed charges,32% of total billed charges,194.56,32,,,percent of total billed charges,32% of total billed charges,559.36,92,,,percent of total billed charges,92% of total billed charges,51.71,559.36,
OSU HC MCG IP SITU 100-300 CELLS,2001855,CDM,310,RC,88275,HCPCS,Outpatient,,,416,353.6,,337.79,81.2,,,percent of total billed charges,81.2% of total billed charges,135.78,32.64,,,percent of total billed charges,32.64% of total billed charges,307.84,74,,,percent of total billed charges,74% of total billed charges,307.84,74,,,percent of total billed charges,74% of total billed charges,133.12,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,133.12,32,,,percent of total billed charges,32% of total billed charges,295.36,71,,,percent of total billed charges,71% of total billed charges,295.36,71,,,percent of total billed charges,71% of total billed charges,278.72,67,,,percent of total billed charges,67% of total billed charges,278.72,67,,,percent of total billed charges,67% of total billed charges,295.36,71,,,percent of total billed charges,71% of total billed charges,316.16,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,137.11,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,368.58,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,133.12,32,,,percent of total billed charges,32% of total billed charges,332.8,80,,,percent of total billed charges,80% of total billed charges,332.8,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,378.56,91,,,percent of total billed charges,91% of total billed charges,135.78,32.64,,,percent of total billed charges,32.64% of total billed charges,133.12,32,,,percent of total billed charges,32% of total billed charges,139.78,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,133.12,32,,,percent of total billed charges,32% of total billed charges,133.12,32,,,percent of total billed charges,32% of total billed charges,382.72,92,,,percent of total billed charges,92% of total billed charges,51.71,382.72,
LAB CORP CHROM ANLYS KARYOTYPE,2001861,CDM,310,RC,88280,HCPCS,Outpatient,,,113,96.05,,91.76,81.2,,,percent of total billed charges,81.2% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,83.62,74,,,percent of total billed charges,74% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,75.71,67,,,percent of total billed charges,67% of total billed charges,80.23,71,,,percent of total billed charges,71% of total billed charges,85.88,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,37.24,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,100.12,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,90.4,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,102.83,91,,,percent of total billed charges,91% of total billed charges,36.88,32.64,,,percent of total billed charges,32.64% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,37.97,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,36.16,32,,,percent of total billed charges,32% of total billed charges,36.16,32,,,percent of total billed charges,32% of total billed charges,103.96,92,,,percent of total billed charges,92% of total billed charges,36.16,103.96,
LAB CORP CHROMOSOME COUNT ADDT,2001863,CDM,310,RC,88285,HCPCS,Outpatient,,,93,79.05,,75.52,81.2,,,percent of total billed charges,81.2% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,68.82,74,,,percent of total billed charges,74% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,62.31,67,,,percent of total billed charges,67% of total billed charges,66.03,71,,,percent of total billed charges,71% of total billed charges,70.68,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,30.65,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,82.4,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,74.4,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,84.63,91,,,percent of total billed charges,91% of total billed charges,30.36,32.64,,,percent of total billed charges,32.64% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,31.25,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,29.76,32,,,percent of total billed charges,32% of total billed charges,29.76,32,,,percent of total billed charges,32% of total billed charges,85.56,92,,,percent of total billed charges,92% of total billed charges,29.76,85.56,
FISH BID CHROM HI RES ANALY,2000920,CDM,300,RC,88289,HCPCS,Outpatient,,,118,100.3,,95.82,81.2,,,percent of total billed charges,81.2% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,87.32,74,,,percent of total billed charges,74% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,79.06,67,,,percent of total billed charges,67% of total billed charges,83.78,71,,,percent of total billed charges,71% of total billed charges,89.68,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,38.89,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,104.55,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,94.4,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,107.38,91,,,percent of total billed charges,91% of total billed charges,38.52,32.64,,,percent of total billed charges,32.64% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,39.65,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,37.76,32,,,percent of total billed charges,32% of total billed charges,37.76,32,,,percent of total billed charges,32% of total billed charges,108.56,92,,,percent of total billed charges,92% of total billed charges,37.76,108.56,
FISH MICRODEL INTERP/REPORT,2000915,CDM,300,RC,88291,HCPCS,Outpatient,,,115,97.75,,93.38,81.2,,,percent of total billed charges,81.2% of total billed charges,37.54,32.64,,,percent of total billed charges,32.64% of total billed charges,85.1,74,,,percent of total billed charges,74% of total billed charges,85.1,74,,,percent of total billed charges,74% of total billed charges,36.8,32,,,percent of total billed charges,32% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,36.8,32,,,percent of total billed charges,32% of total billed charges,81.65,71,,,percent of total billed charges,71% of total billed charges,81.65,71,,,percent of total billed charges,71% of total billed charges,77.05,67,,,percent of total billed charges,67% of total billed charges,77.05,67,,,percent of total billed charges,67% of total billed charges,81.65,71,,,percent of total billed charges,71% of total billed charges,87.4,76,,,percent of total billed charges,76% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,37.9,32.96,,,percent of total billed charges,32.96% of total billed charges,54.29,105,,,Fee Schedule,pays based on EAPG rates,103.5,90,,,percent of total billed charges,90% of total billed charges,103.5,90,,,percent of total billed charges,90% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,101.89,88.6,,,percent of total billed charges,88.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,36.8,32,,,percent of total billed charges,32% of total billed charges,92,80,,,percent of total billed charges,80% of total billed charges,92,80,,,percent of total billed charges,80% of total billed charges,51.71,100,,,Fee Schedule,pays based on EAPG rates,104.65,91,,,percent of total billed charges,91% of total billed charges,37.54,32.64,,,percent of total billed charges,32.64% of total billed charges,36.8,32,,,percent of total billed charges,32% of total billed charges,38.64,33.6,,,percent of total billed charges,33.6% of total billed charges,53.26,103,,,Fee Schedule,pays based on EAPG rates,36.8,32,,,percent of total billed charges,32% of total billed charges,36.8,32,,,percent of total billed charges,32% of total billed charges,105.8,92,,,percent of total billed charges,92% of total billed charges,36.8,105.8,
SURG PATH GROSS LEVEL 1,2000385,CDM,312,RC,88300,HCPCS,Outpatient,,,82,69.7,,66.58,81.2,,,percent of total billed charges,81.2% of total billed charges,26.76,32.64,,,percent of total billed charges,32.64% of total billed charges,60.68,74,,,percent of total billed charges,74% of total billed charges,60.68,74,,,percent of total billed charges,74% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,54.94,67,,,percent of total billed charges,67% of total billed charges,54.94,67,,,percent of total billed charges,67% of total billed charges,58.22,71,,,percent of total billed charges,71% of total billed charges,62.32,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,27.03,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,73.8,90,,,percent of total billed charges,90% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,72.65,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,65.6,80,,,percent of total billed charges,80% of total billed charges,65.6,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,74.62,91,,,percent of total billed charges,91% of total billed charges,26.76,32.64,,,percent of total billed charges,32.64% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,27.55,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,26.24,32,,,percent of total billed charges,32% of total billed charges,26.24,32,,,percent of total billed charges,32% of total billed charges,75.44,92,,,percent of total billed charges,92% of total billed charges,5.52,75.44,
SURG PATH G AND M EXAM LEVEL 2,2000386,CDM,312,RC,88302,HCPCS,Outpatient,,,206,175.1,,167.27,81.2,,,percent of total billed charges,81.2% of total billed charges,67.24,32.64,,,percent of total billed charges,32.64% of total billed charges,152.44,74,,,percent of total billed charges,74% of total billed charges,152.44,74,,,percent of total billed charges,74% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,138.02,67,,,percent of total billed charges,67% of total billed charges,138.02,67,,,percent of total billed charges,67% of total billed charges,146.26,71,,,percent of total billed charges,71% of total billed charges,156.56,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,67.9,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,185.4,90,,,percent of total billed charges,90% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,182.52,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,164.8,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,187.46,91,,,percent of total billed charges,91% of total billed charges,67.24,32.64,,,percent of total billed charges,32.64% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,69.22,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,65.92,32,,,percent of total billed charges,32% of total billed charges,65.92,32,,,percent of total billed charges,32% of total billed charges,189.52,92,,,percent of total billed charges,92% of total billed charges,5.52,189.52,
SURG PATH G AND M EXAM LEVEL 3,2000387,CDM,312,RC,88304,HCPCS,Outpatient,,,230,195.5,,186.76,81.2,,,percent of total billed charges,81.2% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,170.2,74,,,percent of total billed charges,74% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,154.1,67,,,percent of total billed charges,67% of total billed charges,163.3,71,,,percent of total billed charges,71% of total billed charges,174.8,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,75.81,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,203.78,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,184,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,209.3,91,,,percent of total billed charges,91% of total billed charges,75.07,32.64,,,percent of total billed charges,32.64% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,77.28,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,73.6,32,,,percent of total billed charges,32% of total billed charges,73.6,32,,,percent of total billed charges,32% of total billed charges,211.6,92,,,percent of total billed charges,92% of total billed charges,28.01,211.6,
SURG PATH G AND M EXAM LEVEL 4,2000388,CDM,312,RC,88305,HCPCS,Outpatient,,,361,306.85,,293.13,81.2,,,percent of total billed charges,81.2% of total billed charges,117.83,32.64,,,percent of total billed charges,32.64% of total billed charges,267.14,74,,,percent of total billed charges,74% of total billed charges,267.14,74,,,percent of total billed charges,74% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,241.87,67,,,percent of total billed charges,67% of total billed charges,241.87,67,,,percent of total billed charges,67% of total billed charges,256.31,71,,,percent of total billed charges,71% of total billed charges,274.36,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,118.99,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,324.9,90,,,percent of total billed charges,90% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,319.85,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,288.8,80,,,percent of total billed charges,80% of total billed charges,288.8,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,328.51,91,,,percent of total billed charges,91% of total billed charges,117.83,32.64,,,percent of total billed charges,32.64% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,121.3,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,115.52,32,,,percent of total billed charges,32% of total billed charges,115.52,32,,,percent of total billed charges,32% of total billed charges,332.12,92,,,percent of total billed charges,92% of total billed charges,28.01,332.12,
CYTOPATH CELL BLOCK,2000378,CDM,311,RC,88305,HCPCS,Outpatient,,,401,340.85,,325.61,81.2,,,percent of total billed charges,81.2% of total billed charges,130.89,32.64,,,percent of total billed charges,32.64% of total billed charges,296.74,74,,,percent of total billed charges,74% of total billed charges,296.74,74,,,percent of total billed charges,74% of total billed charges,128.32,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,128.32,32,,,percent of total billed charges,32% of total billed charges,284.71,71,,,percent of total billed charges,71% of total billed charges,284.71,71,,,percent of total billed charges,71% of total billed charges,268.67,67,,,percent of total billed charges,67% of total billed charges,268.67,67,,,percent of total billed charges,67% of total billed charges,284.71,71,,,percent of total billed charges,71% of total billed charges,304.76,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,132.17,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,360.9,90,,,percent of total billed charges,90% of total billed charges,360.9,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,355.29,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,128.32,32,,,percent of total billed charges,32% of total billed charges,320.8,80,,,percent of total billed charges,80% of total billed charges,320.8,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,364.91,91,,,percent of total billed charges,91% of total billed charges,130.89,32.64,,,percent of total billed charges,32.64% of total billed charges,128.32,32,,,percent of total billed charges,32% of total billed charges,134.74,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,128.32,32,,,percent of total billed charges,32% of total billed charges,128.32,32,,,percent of total billed charges,32% of total billed charges,368.92,92,,,percent of total billed charges,92% of total billed charges,28.01,368.92,
BONE MARROW CELL BLOCK,2000374,CDM,312,RC,88305,HCPCS,Outpatient,,,416,353.6,,337.79,81.2,,,percent of total billed charges,81.2% of total billed charges,135.78,32.64,,,percent of total billed charges,32.64% of total billed charges,307.84,74,,,percent of total billed charges,74% of total billed charges,307.84,74,,,percent of total billed charges,74% of total billed charges,133.12,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,133.12,32,,,percent of total billed charges,32% of total billed charges,295.36,71,,,percent of total billed charges,71% of total billed charges,295.36,71,,,percent of total billed charges,71% of total billed charges,278.72,67,,,percent of total billed charges,67% of total billed charges,278.72,67,,,percent of total billed charges,67% of total billed charges,295.36,71,,,percent of total billed charges,71% of total billed charges,316.16,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,137.11,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,368.58,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,133.12,32,,,percent of total billed charges,32% of total billed charges,332.8,80,,,percent of total billed charges,80% of total billed charges,332.8,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,378.56,91,,,percent of total billed charges,91% of total billed charges,135.78,32.64,,,percent of total billed charges,32.64% of total billed charges,133.12,32,,,percent of total billed charges,32% of total billed charges,139.78,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,133.12,32,,,percent of total billed charges,32% of total billed charges,133.12,32,,,percent of total billed charges,32% of total billed charges,382.72,92,,,percent of total billed charges,92% of total billed charges,28.01,382.72,
SURG PATH G AND M EXAM LEVEL 5,2000389,CDM,312,RC,88307,HCPCS,Outpatient,,,478,406.3,,388.14,81.2,,,percent of total billed charges,81.2% of total billed charges,156.02,32.64,,,percent of total billed charges,32.64% of total billed charges,353.72,74,,,percent of total billed charges,74% of total billed charges,353.72,74,,,percent of total billed charges,74% of total billed charges,152.96,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,152.96,32,,,percent of total billed charges,32% of total billed charges,339.38,71,,,percent of total billed charges,71% of total billed charges,339.38,71,,,percent of total billed charges,71% of total billed charges,320.26,67,,,percent of total billed charges,67% of total billed charges,320.26,67,,,percent of total billed charges,67% of total billed charges,339.38,71,,,percent of total billed charges,71% of total billed charges,363.28,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,157.55,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,430.2,90,,,percent of total billed charges,90% of total billed charges,430.2,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,423.51,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,152.96,32,,,percent of total billed charges,32% of total billed charges,382.4,80,,,percent of total billed charges,80% of total billed charges,382.4,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,434.98,91,,,percent of total billed charges,91% of total billed charges,156.02,32.64,,,percent of total billed charges,32.64% of total billed charges,152.96,32,,,percent of total billed charges,32% of total billed charges,160.61,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,152.96,32,,,percent of total billed charges,32% of total billed charges,152.96,32,,,percent of total billed charges,32% of total billed charges,439.76,92,,,percent of total billed charges,92% of total billed charges,37.42,439.76,
SURG PATH G AND M EXAM LEVEL 6,2000390,CDM,312,RC,88309,HCPCS,Outpatient,,,649,551.65,,526.99,81.2,,,percent of total billed charges,81.2% of total billed charges,211.83,32.64,,,percent of total billed charges,32.64% of total billed charges,480.26,74,,,percent of total billed charges,74% of total billed charges,480.26,74,,,percent of total billed charges,74% of total billed charges,207.68,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,207.68,32,,,percent of total billed charges,32% of total billed charges,460.79,71,,,percent of total billed charges,71% of total billed charges,460.79,71,,,percent of total billed charges,71% of total billed charges,434.83,67,,,percent of total billed charges,67% of total billed charges,434.83,67,,,percent of total billed charges,67% of total billed charges,460.79,71,,,percent of total billed charges,71% of total billed charges,493.24,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,213.91,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,584.1,90,,,percent of total billed charges,90% of total billed charges,584.1,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,575.01,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,207.68,32,,,percent of total billed charges,32% of total billed charges,519.2,80,,,percent of total billed charges,80% of total billed charges,519.2,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,590.59,91,,,percent of total billed charges,91% of total billed charges,211.83,32.64,,,percent of total billed charges,32.64% of total billed charges,207.68,32,,,percent of total billed charges,32% of total billed charges,218.06,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,207.68,32,,,percent of total billed charges,32% of total billed charges,207.68,32,,,percent of total billed charges,32% of total billed charges,597.08,92,,,percent of total billed charges,92% of total billed charges,37.42,597.08,
BONE MARROW DECALCIFICATION,2000375,CDM,312,RC,88311,HCPCS,Outpatient,,,34,28.9,,27.61,81.2,,,percent of total billed charges,81.2% of total billed charges,11.1,32.64,,,percent of total billed charges,32.64% of total billed charges,25.16,74,,,percent of total billed charges,74% of total billed charges,25.16,74,,,percent of total billed charges,74% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,10.88,32,,,percent of total billed charges,32% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,22.78,67,,,percent of total billed charges,67% of total billed charges,22.78,67,,,percent of total billed charges,67% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,25.84,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,11.21,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,30.6,90,,,percent of total billed charges,90% of total billed charges,30.6,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,30.12,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,10.88,32,,,percent of total billed charges,32% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,30.94,91,,,percent of total billed charges,91% of total billed charges,11.1,32.64,,,percent of total billed charges,32.64% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,11.42,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,10.88,32,,,percent of total billed charges,32% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,31.28,92,,,percent of total billed charges,92% of total billed charges,5.52,31.28,
SPECIAL STAIN GROUP 1,2000391,CDM,312,RC,88312,HCPCS,Outpatient,,,272,231.2,,220.86,81.2,,,percent of total billed charges,81.2% of total billed charges,88.78,32.64,,,percent of total billed charges,32.64% of total billed charges,201.28,74,,,percent of total billed charges,74% of total billed charges,201.28,74,,,percent of total billed charges,74% of total billed charges,87.04,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,87.04,32,,,percent of total billed charges,32% of total billed charges,193.12,71,,,percent of total billed charges,71% of total billed charges,193.12,71,,,percent of total billed charges,71% of total billed charges,182.24,67,,,percent of total billed charges,67% of total billed charges,182.24,67,,,percent of total billed charges,67% of total billed charges,193.12,71,,,percent of total billed charges,71% of total billed charges,206.72,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,89.65,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,244.8,90,,,percent of total billed charges,90% of total billed charges,244.8,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,240.99,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,87.04,32,,,percent of total billed charges,32% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,217.6,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,247.52,91,,,percent of total billed charges,91% of total billed charges,88.78,32.64,,,percent of total billed charges,32.64% of total billed charges,87.04,32,,,percent of total billed charges,32% of total billed charges,91.39,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,87.04,32,,,percent of total billed charges,32% of total billed charges,87.04,32,,,percent of total billed charges,32% of total billed charges,250.24,92,,,percent of total billed charges,92% of total billed charges,28.01,250.24,
SPECIAL STAIN GROUP 2,2000392,CDM,312,RC,88313,HCPCS,Outpatient,,,228,193.8,,185.14,81.2,,,percent of total billed charges,81.2% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,168.72,74,,,percent of total billed charges,74% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,72.96,32,,,percent of total billed charges,32% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,152.76,67,,,percent of total billed charges,67% of total billed charges,161.88,71,,,percent of total billed charges,71% of total billed charges,173.28,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,75.15,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,202.01,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,72.96,32,,,percent of total billed charges,32% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,182.4,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,207.48,91,,,percent of total billed charges,91% of total billed charges,74.42,32.64,,,percent of total billed charges,32.64% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,76.61,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,72.96,32,,,percent of total billed charges,32% of total billed charges,72.96,32,,,percent of total billed charges,32% of total billed charges,209.76,92,,,percent of total billed charges,92% of total billed charges,5.52,209.76,
FROZEN SECTION,2000398,CDM,312,RC,88331,HCPCS,Outpatient,,,119,101.15,,96.63,81.2,,,percent of total billed charges,81.2% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,90.44,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,39.22,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,105.43,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,108.29,91,,,percent of total billed charges,91% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,39.98,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,109.48,92,,,percent of total billed charges,92% of total billed charges,28.01,109.48,
FROZEN SECTION MULTIPLE,2000399,CDM,312,RC,88332,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
TOUCH PREP INITIAL SITE,2000945,CDM,300,RC,88333,HCPCS,Outpatient,,,119,101.15,,96.63,81.2,,,percent of total billed charges,81.2% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,88.06,74,,,percent of total billed charges,74% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,79.73,67,,,percent of total billed charges,67% of total billed charges,84.49,71,,,percent of total billed charges,71% of total billed charges,90.44,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,39.22,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,105.43,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,95.2,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,108.29,91,,,percent of total billed charges,91% of total billed charges,38.84,32.64,,,percent of total billed charges,32.64% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,39.98,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,38.08,32,,,percent of total billed charges,32% of total billed charges,38.08,32,,,percent of total billed charges,32% of total billed charges,109.48,92,,,percent of total billed charges,92% of total billed charges,28.01,109.48,
TOUCH PREP ADDITIONAL SITE,2000946,CDM,300,RC,88334,HCPCS,Outpatient,,,75,63.75,,60.9,81.2,,,percent of total billed charges,81.2% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,55.5,74,,,percent of total billed charges,74% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,50.25,67,,,percent of total billed charges,67% of total billed charges,53.25,71,,,percent of total billed charges,71% of total billed charges,57,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,24.72,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,66.45,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,60,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,68.25,91,,,percent of total billed charges,91% of total billed charges,24.48,32.64,,,percent of total billed charges,32.64% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,25.2,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,24,32,,,percent of total billed charges,32% of total billed charges,24,32,,,percent of total billed charges,32% of total billed charges,69,92,,,percent of total billed charges,92% of total billed charges,24,69,
SUBSEQUENT IMMUNOHISTOCHEMICAL STAIN,2001365,CDM,310,RC,88341,HCPCS,Outpatient,,,223,189.55,,181.08,81.2,,,percent of total billed charges,81.2% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,165.02,74,,,percent of total billed charges,74% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,149.41,67,,,percent of total billed charges,67% of total billed charges,158.33,71,,,percent of total billed charges,71% of total billed charges,169.48,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,73.5,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,197.58,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,178.4,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,202.93,91,,,percent of total billed charges,91% of total billed charges,72.79,32.64,,,percent of total billed charges,32.64% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,74.93,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,71.36,32,,,percent of total billed charges,32% of total billed charges,71.36,32,,,percent of total billed charges,32% of total billed charges,205.16,92,,,percent of total billed charges,92% of total billed charges,37.42,205.16,
IMMUNOHISTOCHEMICAL STAIN,2000393,CDM,310,RC,88342,HCPCS,Outpatient,,,213,181.05,,172.96,81.2,,,percent of total billed charges,81.2% of total billed charges,69.52,32.64,,,percent of total billed charges,32.64% of total billed charges,157.62,74,,,percent of total billed charges,74% of total billed charges,157.62,74,,,percent of total billed charges,74% of total billed charges,68.16,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,68.16,32,,,percent of total billed charges,32% of total billed charges,151.23,71,,,percent of total billed charges,71% of total billed charges,151.23,71,,,percent of total billed charges,71% of total billed charges,142.71,67,,,percent of total billed charges,67% of total billed charges,142.71,67,,,percent of total billed charges,67% of total billed charges,151.23,71,,,percent of total billed charges,71% of total billed charges,161.88,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,70.2,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,191.7,90,,,percent of total billed charges,90% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,188.72,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,68.16,32,,,percent of total billed charges,32% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,170.4,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,193.83,91,,,percent of total billed charges,91% of total billed charges,69.52,32.64,,,percent of total billed charges,32.64% of total billed charges,68.16,32,,,percent of total billed charges,32% of total billed charges,71.57,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,68.16,32,,,percent of total billed charges,32% of total billed charges,68.16,32,,,percent of total billed charges,32% of total billed charges,195.96,92,,,percent of total billed charges,92% of total billed charges,28.01,195.96,
PIN 4,2001404,CDM,310,RC,88344,HCPCS,Outpatient,,,437,371.45,,354.84,81.2,,,percent of total billed charges,81.2% of total billed charges,142.64,32.64,,,percent of total billed charges,32.64% of total billed charges,323.38,74,,,percent of total billed charges,74% of total billed charges,323.38,74,,,percent of total billed charges,74% of total billed charges,139.84,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,139.84,32,,,percent of total billed charges,32% of total billed charges,310.27,71,,,percent of total billed charges,71% of total billed charges,310.27,71,,,percent of total billed charges,71% of total billed charges,292.79,67,,,percent of total billed charges,67% of total billed charges,292.79,67,,,percent of total billed charges,67% of total billed charges,310.27,71,,,percent of total billed charges,71% of total billed charges,332.12,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,144.04,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,393.3,90,,,percent of total billed charges,90% of total billed charges,393.3,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,387.18,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,139.84,32,,,percent of total billed charges,32% of total billed charges,349.6,80,,,percent of total billed charges,80% of total billed charges,349.6,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,397.67,91,,,percent of total billed charges,91% of total billed charges,142.64,32.64,,,percent of total billed charges,32.64% of total billed charges,139.84,32,,,percent of total billed charges,32% of total billed charges,146.83,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,139.84,32,,,percent of total billed charges,32% of total billed charges,139.84,32,,,percent of total billed charges,32% of total billed charges,402.04,92,,,percent of total billed charges,92% of total billed charges,37.42,402.04,
BREAST IMMUNOASSAY,2001026,CDM,310,RC,88360,HCPCS,Outpatient,,,414,351.9,,336.17,81.2,,,percent of total billed charges,81.2% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,314.64,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,136.45,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,372.6,90,,,percent of total billed charges,90% of total billed charges,372.6,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,366.8,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,376.74,91,,,percent of total billed charges,91% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,139.1,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,380.88,92,,,percent of total billed charges,92% of total billed charges,37.42,380.88,
INSITU HYDRID FISH EA ADDTL (PATH),2001800,CDM,310,RC,88364,HCPCS,Outpatient,,,621,527.85,,504.25,81.2,,,percent of total billed charges,81.2% of total billed charges,202.69,32.64,,,percent of total billed charges,32.64% of total billed charges,459.54,74,,,percent of total billed charges,74% of total billed charges,459.54,74,,,percent of total billed charges,74% of total billed charges,198.72,32,,,percent of total billed charges,32% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,198.72,32,,,percent of total billed charges,32% of total billed charges,440.91,71,,,percent of total billed charges,71% of total billed charges,440.91,71,,,percent of total billed charges,71% of total billed charges,416.07,67,,,percent of total billed charges,67% of total billed charges,416.07,67,,,percent of total billed charges,67% of total billed charges,440.91,71,,,percent of total billed charges,71% of total billed charges,471.96,76,,,percent of total billed charges,76% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,204.68,32.96,,,percent of total billed charges,32.96% of total billed charges,29.41,105,,,Fee Schedule,pays based on EAPG rates,558.9,90,,,percent of total billed charges,90% of total billed charges,558.9,90,,,percent of total billed charges,90% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,550.21,88.6,,,percent of total billed charges,88.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,198.72,32,,,percent of total billed charges,32% of total billed charges,496.8,80,,,percent of total billed charges,80% of total billed charges,496.8,80,,,percent of total billed charges,80% of total billed charges,28.01,100,,,Fee Schedule,pays based on EAPG rates,565.11,91,,,percent of total billed charges,91% of total billed charges,202.69,32.64,,,percent of total billed charges,32.64% of total billed charges,198.72,32,,,percent of total billed charges,32% of total billed charges,208.66,33.6,,,percent of total billed charges,33.6% of total billed charges,28.85,103,,,Fee Schedule,pays based on EAPG rates,198.72,32,,,percent of total billed charges,32% of total billed charges,198.72,32,,,percent of total billed charges,32% of total billed charges,571.32,92,,,percent of total billed charges,92% of total billed charges,28.01,571.32,
INSITU HYDRID FISH INITIAL (PATH),2001799,CDM,310,RC,88365,HCPCS,Outpatient,,,621,527.85,,504.25,81.2,,,percent of total billed charges,81.2% of total billed charges,202.69,32.64,,,percent of total billed charges,32.64% of total billed charges,459.54,74,,,percent of total billed charges,74% of total billed charges,459.54,74,,,percent of total billed charges,74% of total billed charges,198.72,32,,,percent of total billed charges,32% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,198.72,32,,,percent of total billed charges,32% of total billed charges,440.91,71,,,percent of total billed charges,71% of total billed charges,440.91,71,,,percent of total billed charges,71% of total billed charges,416.07,67,,,percent of total billed charges,67% of total billed charges,416.07,67,,,percent of total billed charges,67% of total billed charges,440.91,71,,,percent of total billed charges,71% of total billed charges,471.96,76,,,percent of total billed charges,76% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,204.68,32.96,,,percent of total billed charges,32.96% of total billed charges,39.29,105,,,Fee Schedule,pays based on EAPG rates,558.9,90,,,percent of total billed charges,90% of total billed charges,558.9,90,,,percent of total billed charges,90% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,550.21,88.6,,,percent of total billed charges,88.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,198.72,32,,,percent of total billed charges,32% of total billed charges,496.8,80,,,percent of total billed charges,80% of total billed charges,496.8,80,,,percent of total billed charges,80% of total billed charges,37.42,100,,,Fee Schedule,pays based on EAPG rates,565.11,91,,,percent of total billed charges,91% of total billed charges,202.69,32.64,,,percent of total billed charges,32.64% of total billed charges,198.72,32,,,percent of total billed charges,32% of total billed charges,208.66,33.6,,,percent of total billed charges,33.6% of total billed charges,38.54,103,,,Fee Schedule,pays based on EAPG rates,198.72,32,,,percent of total billed charges,32% of total billed charges,198.72,32,,,percent of total billed charges,32% of total billed charges,571.32,92,,,percent of total billed charges,92% of total billed charges,37.42,571.32,
BODY FLUID CELL COUNT,2000176,CDM,309,RC,89051,HCPCS,Outpatient,,,36,30.6,,29.23,81.2,,,percent of total billed charges,81.2% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,27.36,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,11.87,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,32.4,90,,,percent of total billed charges,90% of total billed charges,32.4,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,31.9,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,32.76,91,,,percent of total billed charges,91% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,12.1,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,11.52,32,,,percent of total billed charges,32% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,33.12,92,,,percent of total billed charges,92% of total billed charges,5.52,33.12,
SPINAL FLUID CELL COUNT,2000177,CDM,309,RC,89051,HCPCS,Outpatient,,,37,31.45,,30.04,81.2,,,percent of total billed charges,81.2% of total billed charges,12.08,32.64,,,percent of total billed charges,32.64% of total billed charges,27.38,74,,,percent of total billed charges,74% of total billed charges,27.38,74,,,percent of total billed charges,74% of total billed charges,11.84,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,11.84,32,,,percent of total billed charges,32% of total billed charges,26.27,71,,,percent of total billed charges,71% of total billed charges,26.27,71,,,percent of total billed charges,71% of total billed charges,24.79,67,,,percent of total billed charges,67% of total billed charges,24.79,67,,,percent of total billed charges,67% of total billed charges,26.27,71,,,percent of total billed charges,71% of total billed charges,28.12,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,12.2,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,33.3,90,,,percent of total billed charges,90% of total billed charges,33.3,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,32.78,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,11.84,32,,,percent of total billed charges,32% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,29.6,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,33.67,91,,,percent of total billed charges,91% of total billed charges,12.08,32.64,,,percent of total billed charges,32.64% of total billed charges,11.84,32,,,percent of total billed charges,32% of total billed charges,12.43,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,11.84,32,,,percent of total billed charges,32% of total billed charges,11.84,32,,,percent of total billed charges,32% of total billed charges,34.04,92,,,percent of total billed charges,92% of total billed charges,5.52,34.04,
CELL COUNT SEROUS FLUID,2001472,CDM,309,RC,89051,HCPCS,Outpatient,,,120,102,,97.44,81.2,,,percent of total billed charges,81.2% of total billed charges,39.17,32.64,,,percent of total billed charges,32.64% of total billed charges,88.8,74,,,percent of total billed charges,74% of total billed charges,88.8,74,,,percent of total billed charges,74% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,80.4,67,,,percent of total billed charges,67% of total billed charges,80.4,67,,,percent of total billed charges,67% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,91.2,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,39.55,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,106.32,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,96,80,,,percent of total billed charges,80% of total billed charges,96,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,109.2,91,,,percent of total billed charges,91% of total billed charges,39.17,32.64,,,percent of total billed charges,32.64% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,40.32,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,110.4,92,,,percent of total billed charges,92% of total billed charges,5.52,110.4,
CELL CT SYNOVIAL W/O CRYSTALS,2001451,CDM,309,RC,89051,HCPCS,Outpatient,,,195,165.75,,158.34,81.2,,,percent of total billed charges,81.2% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,144.3,74,,,percent of total billed charges,74% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,130.65,67,,,percent of total billed charges,67% of total billed charges,138.45,71,,,percent of total billed charges,71% of total billed charges,148.2,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,64.27,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,172.77,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,156,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,177.45,91,,,percent of total billed charges,91% of total billed charges,63.65,32.64,,,percent of total billed charges,32.64% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,65.52,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,62.4,32,,,percent of total billed charges,32% of total billed charges,62.4,32,,,percent of total billed charges,32% of total billed charges,179.4,92,,,percent of total billed charges,92% of total billed charges,5.52,179.4,
SYNOVIAL CELL CT W/CRYSTALS,2001458,CDM,309,RC,89051,HCPCS,Outpatient,,,286,243.1,,232.23,81.2,,,percent of total billed charges,81.2% of total billed charges,93.35,32.64,,,percent of total billed charges,32.64% of total billed charges,211.64,74,,,percent of total billed charges,74% of total billed charges,211.64,74,,,percent of total billed charges,74% of total billed charges,91.52,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,91.52,32,,,percent of total billed charges,32% of total billed charges,203.06,71,,,percent of total billed charges,71% of total billed charges,203.06,71,,,percent of total billed charges,71% of total billed charges,191.62,67,,,percent of total billed charges,67% of total billed charges,191.62,67,,,percent of total billed charges,67% of total billed charges,203.06,71,,,percent of total billed charges,71% of total billed charges,217.36,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,94.27,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,257.4,90,,,percent of total billed charges,90% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,253.4,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,91.52,32,,,percent of total billed charges,32% of total billed charges,228.8,80,,,percent of total billed charges,80% of total billed charges,228.8,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,260.26,91,,,percent of total billed charges,91% of total billed charges,93.35,32.64,,,percent of total billed charges,32.64% of total billed charges,91.52,32,,,percent of total billed charges,32% of total billed charges,96.1,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,91.52,32,,,percent of total billed charges,32% of total billed charges,91.52,32,,,percent of total billed charges,32% of total billed charges,263.12,92,,,percent of total billed charges,92% of total billed charges,5.52,263.12,
FECAL WBCS,2000241,CDM,300,RC,89055,HCPCS,Outpatient,,,64,54.4,,51.97,81.2,,,percent of total billed charges,81.2% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,47.36,74,,,percent of total billed charges,74% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,42.88,67,,,percent of total billed charges,67% of total billed charges,45.44,71,,,percent of total billed charges,71% of total billed charges,48.64,76,,,percent of total billed charges,76% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,21.09,32.96,,,percent of total billed charges,32.96% of total billed charges,5.49,105,,,Fee Schedule,pays based on EAPG rates,57.6,90,,,percent of total billed charges,90% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,56.7,88.6,,,percent of total billed charges,88.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,51.2,80,,,percent of total billed charges,80% of total billed charges,5.23,100,,,Fee Schedule,pays based on EAPG rates,58.24,91,,,percent of total billed charges,91% of total billed charges,20.89,32.64,,,percent of total billed charges,32.64% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,21.5,33.6,,,percent of total billed charges,33.6% of total billed charges,5.38,103,,,Fee Schedule,pays based on EAPG rates,20.48,32,,,percent of total billed charges,32% of total billed charges,20.48,32,,,percent of total billed charges,32% of total billed charges,58.88,92,,,percent of total billed charges,92% of total billed charges,5.23,58.88,
BF SYNOVIAL CRYSTALS,2001853,CDM,309,RC,89060,HCPCS,Outpatient,,,23,19.55,,18.68,81.2,,,percent of total billed charges,81.2% of total billed charges,7.51,32.64,,,percent of total billed charges,32.64% of total billed charges,17.02,74,,,percent of total billed charges,74% of total billed charges,17.02,74,,,percent of total billed charges,74% of total billed charges,7.36,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,7.36,32,,,percent of total billed charges,32% of total billed charges,16.33,71,,,percent of total billed charges,71% of total billed charges,16.33,71,,,percent of total billed charges,71% of total billed charges,15.41,67,,,percent of total billed charges,67% of total billed charges,15.41,67,,,percent of total billed charges,67% of total billed charges,16.33,71,,,percent of total billed charges,71% of total billed charges,17.48,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,7.58,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,20.7,90,,,percent of total billed charges,90% of total billed charges,20.7,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,20.38,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,7.36,32,,,percent of total billed charges,32% of total billed charges,18.4,80,,,percent of total billed charges,80% of total billed charges,18.4,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,20.93,91,,,percent of total billed charges,91% of total billed charges,7.51,32.64,,,percent of total billed charges,32.64% of total billed charges,7.36,32,,,percent of total billed charges,32% of total billed charges,7.73,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,7.36,32,,,percent of total billed charges,32% of total billed charges,7.36,32,,,percent of total billed charges,32% of total billed charges,21.16,92,,,percent of total billed charges,92% of total billed charges,5.52,21.16,
CRYSTAL ID BY POLARIZED LIGHT,2000171,CDM,309,RC,89060,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,5.52,39.56,
SPERM COUNT POST VASECTOMY,2000134,CDM,309,RC,89321,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,5.79,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,5.52,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,5.68,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,5.52,70.84,
THERAPEUTIC PHLEBOTOMY,2000155,CDM,940,RC,99195,HCPCS,Outpatient,,,43,36.55,,34.92,81.2,,,percent of total billed charges,81.2% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,31.82,74,,,percent of total billed charges,74% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,28.81,67,,,percent of total billed charges,67% of total billed charges,30.53,71,,,percent of total billed charges,71% of total billed charges,32.68,76,,,percent of total billed charges,76% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,14.17,32.96,,,percent of total billed charges,32.96% of total billed charges,23.1,105,,,Fee Schedule,pays based on EAPG rates,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,22,100,,,Fee Schedule,pays based on EAPG rates,38.1,88.6,,,percent of total billed charges,88.6% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,34.4,80,,,percent of total billed charges,80% of total billed charges,22,100,,,Fee Schedule,pays based on EAPG rates,39.13,91,,,percent of total billed charges,91% of total billed charges,14.04,32.64,,,percent of total billed charges,32.64% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,14.45,33.6,,,percent of total billed charges,33.6% of total billed charges,22.66,103,,,Fee Schedule,pays based on EAPG rates,13.76,32,,,percent of total billed charges,32% of total billed charges,13.76,32,,,percent of total billed charges,32% of total billed charges,39.56,92,,,percent of total billed charges,92% of total billed charges,13.76,39.56,
RESPIRATORY PROFILE 2.1,2001816,CDM,310,RC,0202U,HCPCS,Outpatient,,,1028,873.8,,834.74,81.2,,,percent of total billed charges,81.2% of total billed charges,335.54,32.64,,,percent of total billed charges,32.64% of total billed charges,760.72,74,,,percent of total billed charges,74% of total billed charges,760.72,74,,,percent of total billed charges,74% of total billed charges,328.96,32,,,percent of total billed charges,32% of total billed charges,31.18,103,,,Fee Schedule,pays based on EAPG rates,328.96,32,,,percent of total billed charges,32% of total billed charges,729.88,71,,,percent of total billed charges,71% of total billed charges,729.88,71,,,percent of total billed charges,71% of total billed charges,688.76,67,,,percent of total billed charges,67% of total billed charges,688.76,67,,,percent of total billed charges,67% of total billed charges,729.88,71,,,percent of total billed charges,71% of total billed charges,781.28,76,,,percent of total billed charges,76% of total billed charges,31.18,103,,,Fee Schedule,pays based on EAPG rates,338.83,32.96,,,percent of total billed charges,32.96% of total billed charges,31.79,105,,,Fee Schedule,pays based on EAPG rates,925.2,90,,,percent of total billed charges,90% of total billed charges,925.2,90,,,percent of total billed charges,90% of total billed charges,30.27,100,,,Fee Schedule,pays based on EAPG rates,910.81,88.6,,,percent of total billed charges,88.6% of total billed charges,31.18,103,,,Fee Schedule,pays based on EAPG rates,328.96,32,,,percent of total billed charges,32% of total billed charges,822.4,80,,,percent of total billed charges,80% of total billed charges,822.4,80,,,percent of total billed charges,80% of total billed charges,30.27,100,,,Fee Schedule,pays based on EAPG rates,935.48,91,,,percent of total billed charges,91% of total billed charges,335.54,32.64,,,percent of total billed charges,32.64% of total billed charges,328.96,32,,,percent of total billed charges,32% of total billed charges,345.41,33.6,,,percent of total billed charges,33.6% of total billed charges,31.18,103,,,Fee Schedule,pays based on EAPG rates,328.96,32,,,percent of total billed charges,32% of total billed charges,328.96,32,,,percent of total billed charges,32% of total billed charges,945.76,92,,,percent of total billed charges,92% of total billed charges,30.27,945.76,
"PCR 4-PLEX (FLU A/B, RSV, COVID)",2001840,CDM,310,RC,0241U,HCPCS,Outpatient,,,439,373.15,,356.47,81.2,,,percent of total billed charges,81.2% of total billed charges,143.29,32.64,,,percent of total billed charges,32.64% of total billed charges,324.86,74,,,percent of total billed charges,74% of total billed charges,324.86,74,,,percent of total billed charges,74% of total billed charges,140.48,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,140.48,32,,,percent of total billed charges,32% of total billed charges,311.69,71,,,percent of total billed charges,71% of total billed charges,311.69,71,,,percent of total billed charges,71% of total billed charges,294.13,67,,,percent of total billed charges,67% of total billed charges,294.13,67,,,percent of total billed charges,67% of total billed charges,311.69,71,,,percent of total billed charges,71% of total billed charges,333.64,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,144.69,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,395.1,90,,,percent of total billed charges,90% of total billed charges,395.1,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,388.95,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,140.48,32,,,percent of total billed charges,32% of total billed charges,351.2,80,,,percent of total billed charges,80% of total billed charges,351.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,399.49,91,,,percent of total billed charges,91% of total billed charges,143.29,32.64,,,percent of total billed charges,32.64% of total billed charges,140.48,32,,,percent of total billed charges,32% of total billed charges,147.5,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,140.48,32,,,percent of total billed charges,32% of total billed charges,140.48,32,,,percent of total billed charges,32% of total billed charges,403.88,92,,,percent of total billed charges,92% of total billed charges,140.48,403.88,
BB CRYOPRECIPITATE POOLED,2001491,CDM,380,RC,P9012,HCPCS,Outpatient,,,510,433.5,,414.12,81.2,,,percent of total billed charges,81.2% of total billed charges,166.46,32.64,,,percent of total billed charges,32.64% of total billed charges,377.4,74,,,percent of total billed charges,74% of total billed charges,377.4,74,,,percent of total billed charges,74% of total billed charges,163.2,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,163.2,32,,,percent of total billed charges,32% of total billed charges,362.1,71,,,percent of total billed charges,71% of total billed charges,362.1,71,,,percent of total billed charges,71% of total billed charges,341.7,67,,,percent of total billed charges,67% of total billed charges,341.7,67,,,percent of total billed charges,67% of total billed charges,362.1,71,,,percent of total billed charges,71% of total billed charges,387.6,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,168.1,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,459,90,,,percent of total billed charges,90% of total billed charges,459,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,451.86,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,163.2,32,,,percent of total billed charges,32% of total billed charges,408,80,,,percent of total billed charges,80% of total billed charges,408,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,464.1,91,,,percent of total billed charges,91% of total billed charges,166.46,32.64,,,percent of total billed charges,32.64% of total billed charges,163.2,32,,,percent of total billed charges,32% of total billed charges,171.36,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,163.2,32,,,percent of total billed charges,32% of total billed charges,163.2,32,,,percent of total billed charges,32% of total billed charges,469.2,92,,,percent of total billed charges,92% of total billed charges,163.2,469.2,
BB PLASMA FRESH FROZEN,2000113,CDM,390,RC,P9017,HCPCS,Outpatient,,,150,127.5,,121.8,81.2,,,percent of total billed charges,81.2% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,114,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,49.44,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,135,90,,,percent of total billed charges,90% of total billed charges,135,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,132.9,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,136.5,91,,,percent of total billed charges,91% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,50.4,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,138,92,,,percent of total billed charges,92% of total billed charges,48,293.63,
BB PRBC LEUKO REDUCED,2000688,CDM,390,RC,P9021,HCPCS,Outpatient,,,331,281.35,,268.77,81.2,,,percent of total billed charges,81.2% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,251.56,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,109.1,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,293.27,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,301.21,91,,,percent of total billed charges,91% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,111.22,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,304.52,92,,,percent of total billed charges,92% of total billed charges,105.92,304.52,
BB PLT PHERESIS LEUKO REDUCED,2000794,CDM,390,RC,P9035,HCPCS,Outpatient,,,1335,1134.75,,1084.02,81.2,,,percent of total billed charges,81.2% of total billed charges,435.74,32.64,,,percent of total billed charges,32.64% of total billed charges,987.9,74,,,percent of total billed charges,74% of total billed charges,987.9,74,,,percent of total billed charges,74% of total billed charges,427.2,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,427.2,32,,,percent of total billed charges,32% of total billed charges,947.85,71,,,percent of total billed charges,71% of total billed charges,947.85,71,,,percent of total billed charges,71% of total billed charges,894.45,67,,,percent of total billed charges,67% of total billed charges,894.45,67,,,percent of total billed charges,67% of total billed charges,947.85,71,,,percent of total billed charges,71% of total billed charges,1014.6,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,440.02,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,1201.5,90,,,percent of total billed charges,90% of total billed charges,1201.5,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,1182.81,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,427.2,32,,,percent of total billed charges,32% of total billed charges,1068,80,,,percent of total billed charges,80% of total billed charges,1068,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,1214.85,91,,,percent of total billed charges,91% of total billed charges,435.74,32.64,,,percent of total billed charges,32.64% of total billed charges,427.2,32,,,percent of total billed charges,32% of total billed charges,448.56,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,427.2,32,,,percent of total billed charges,32% of total billed charges,427.2,32,,,percent of total billed charges,32% of total billed charges,1228.2,92,,,percent of total billed charges,92% of total billed charges,279.65,1228.2,
BB PLT PHERESIS IRRADIATED,2000795,CDM,390,RC,P9036,HCPCS,Outpatient,,,1140,969,,925.68,81.2,,,percent of total billed charges,81.2% of total billed charges,372.1,32.64,,,percent of total billed charges,32.64% of total billed charges,843.6,74,,,percent of total billed charges,74% of total billed charges,843.6,74,,,percent of total billed charges,74% of total billed charges,364.8,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,364.8,32,,,percent of total billed charges,32% of total billed charges,809.4,71,,,percent of total billed charges,71% of total billed charges,809.4,71,,,percent of total billed charges,71% of total billed charges,763.8,67,,,percent of total billed charges,67% of total billed charges,763.8,67,,,percent of total billed charges,67% of total billed charges,809.4,71,,,percent of total billed charges,71% of total billed charges,866.4,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,375.74,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,1026,90,,,percent of total billed charges,90% of total billed charges,1026,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,1010.04,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,364.8,32,,,percent of total billed charges,32% of total billed charges,912,80,,,percent of total billed charges,80% of total billed charges,912,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,1037.4,91,,,percent of total billed charges,91% of total billed charges,372.1,32.64,,,percent of total billed charges,32.64% of total billed charges,364.8,32,,,percent of total billed charges,32% of total billed charges,383.04,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,364.8,32,,,percent of total billed charges,32% of total billed charges,364.8,32,,,percent of total billed charges,32% of total billed charges,1048.8,92,,,percent of total billed charges,92% of total billed charges,279.65,1048.8,
BB PLT PHERESIS LEUKO RED IRRADIA,2000796,CDM,390,RC,P9037,HCPCS,Outpatient,,,1356,1152.6,,1101.07,81.2,,,percent of total billed charges,81.2% of total billed charges,442.6,32.64,,,percent of total billed charges,32.64% of total billed charges,1003.44,74,,,percent of total billed charges,74% of total billed charges,1003.44,74,,,percent of total billed charges,74% of total billed charges,433.92,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,433.92,32,,,percent of total billed charges,32% of total billed charges,962.76,71,,,percent of total billed charges,71% of total billed charges,962.76,71,,,percent of total billed charges,71% of total billed charges,908.52,67,,,percent of total billed charges,67% of total billed charges,908.52,67,,,percent of total billed charges,67% of total billed charges,962.76,71,,,percent of total billed charges,71% of total billed charges,1030.56,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,446.94,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,1220.4,90,,,percent of total billed charges,90% of total billed charges,1220.4,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,1201.42,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,433.92,32,,,percent of total billed charges,32% of total billed charges,1084.8,80,,,percent of total billed charges,80% of total billed charges,1084.8,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,1233.96,91,,,percent of total billed charges,91% of total billed charges,442.6,32.64,,,percent of total billed charges,32.64% of total billed charges,433.92,32,,,percent of total billed charges,32% of total billed charges,455.62,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,433.92,32,,,percent of total billed charges,32% of total billed charges,433.92,32,,,percent of total billed charges,32% of total billed charges,1247.52,92,,,percent of total billed charges,92% of total billed charges,279.65,1247.52,
BB PRBC LEUKO REDUCED IRRADIATED,2000791,CDM,390,RC,P9040,HCPCS,Outpatient,,,416,353.6,,337.79,81.2,,,percent of total billed charges,81.2% of total billed charges,135.78,32.64,,,percent of total billed charges,32.64% of total billed charges,307.84,74,,,percent of total billed charges,74% of total billed charges,307.84,74,,,percent of total billed charges,74% of total billed charges,133.12,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,133.12,32,,,percent of total billed charges,32% of total billed charges,295.36,71,,,percent of total billed charges,71% of total billed charges,295.36,71,,,percent of total billed charges,71% of total billed charges,278.72,67,,,percent of total billed charges,67% of total billed charges,278.72,67,,,percent of total billed charges,67% of total billed charges,295.36,71,,,percent of total billed charges,71% of total billed charges,316.16,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,137.11,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,368.58,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,133.12,32,,,percent of total billed charges,32% of total billed charges,332.8,80,,,percent of total billed charges,80% of total billed charges,332.8,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,378.56,91,,,percent of total billed charges,91% of total billed charges,135.78,32.64,,,percent of total billed charges,32.64% of total billed charges,133.12,32,,,percent of total billed charges,32% of total billed charges,139.78,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,133.12,32,,,percent of total billed charges,32% of total billed charges,133.12,32,,,percent of total billed charges,32% of total billed charges,382.72,92,,,percent of total billed charges,92% of total billed charges,133.12,382.72,
CF AMP NUCLEIC ACID,2000642,CDM,301,RC,,,Outpatient,,,6,5.1,,4.87,81.2,,,percent of total billed charges,81.2% of total billed charges,1.96,32.64,,,percent of total billed charges,32.64% of total billed charges,4.44,74,,,percent of total billed charges,74% of total billed charges,4.44,74,,,percent of total billed charges,74% of total billed charges,1.92,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,1.92,32,,,percent of total billed charges,32% of total billed charges,4.26,71,,,percent of total billed charges,71% of total billed charges,4.26,71,,,percent of total billed charges,71% of total billed charges,4.02,67,,,percent of total billed charges,67% of total billed charges,4.02,67,,,percent of total billed charges,67% of total billed charges,4.26,71,,,percent of total billed charges,71% of total billed charges,4.56,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,1.98,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,5.4,90,,,percent of total billed charges,90% of total billed charges,5.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,5.32,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,1.92,32,,,percent of total billed charges,32% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,5.46,91,,,percent of total billed charges,91% of total billed charges,1.96,32.64,,,percent of total billed charges,32.64% of total billed charges,1.92,32,,,percent of total billed charges,32% of total billed charges,2.02,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,1.92,32,,,percent of total billed charges,32% of total billed charges,1.92,32,,,percent of total billed charges,32% of total billed charges,5.52,92,,,percent of total billed charges,92% of total billed charges,1.92,5.52,
CYSTIC FIBROSIS MUTATION,2000643,CDM,301,RC,,,Outpatient,,,6,5.1,,4.87,81.2,,,percent of total billed charges,81.2% of total billed charges,1.96,32.64,,,percent of total billed charges,32.64% of total billed charges,4.44,74,,,percent of total billed charges,74% of total billed charges,4.44,74,,,percent of total billed charges,74% of total billed charges,1.92,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,1.92,32,,,percent of total billed charges,32% of total billed charges,4.26,71,,,percent of total billed charges,71% of total billed charges,4.26,71,,,percent of total billed charges,71% of total billed charges,4.02,67,,,percent of total billed charges,67% of total billed charges,4.02,67,,,percent of total billed charges,67% of total billed charges,4.26,71,,,percent of total billed charges,71% of total billed charges,4.56,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,1.98,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,5.4,90,,,percent of total billed charges,90% of total billed charges,5.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,5.32,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,1.92,32,,,percent of total billed charges,32% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,4.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,5.46,91,,,percent of total billed charges,91% of total billed charges,1.96,32.64,,,percent of total billed charges,32.64% of total billed charges,1.92,32,,,percent of total billed charges,32% of total billed charges,2.02,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,1.92,32,,,percent of total billed charges,32% of total billed charges,1.92,32,,,percent of total billed charges,32% of total billed charges,5.52,92,,,percent of total billed charges,92% of total billed charges,1.92,5.52,
CF INTERP,2000645,CDM,301,RC,,,Outpatient,,,13,11.05,,10.56,81.2,,,percent of total billed charges,81.2% of total billed charges,4.24,32.64,,,percent of total billed charges,32.64% of total billed charges,9.62,74,,,percent of total billed charges,74% of total billed charges,9.62,74,,,percent of total billed charges,74% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,4.16,32,,,percent of total billed charges,32% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,8.71,67,,,percent of total billed charges,67% of total billed charges,8.71,67,,,percent of total billed charges,67% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,9.88,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,4.28,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,11.7,90,,,percent of total billed charges,90% of total billed charges,11.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,11.52,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,4.16,32,,,percent of total billed charges,32% of total billed charges,10.4,80,,,percent of total billed charges,80% of total billed charges,10.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,11.83,91,,,percent of total billed charges,91% of total billed charges,4.24,32.64,,,percent of total billed charges,32.64% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,4.37,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,4.16,32,,,percent of total billed charges,32% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,11.96,92,,,percent of total billed charges,92% of total billed charges,4.16,11.96,
CF SEPARATION,2000641,CDM,301,RC,,,Outpatient,,,13,11.05,,10.56,81.2,,,percent of total billed charges,81.2% of total billed charges,4.24,32.64,,,percent of total billed charges,32.64% of total billed charges,9.62,74,,,percent of total billed charges,74% of total billed charges,9.62,74,,,percent of total billed charges,74% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,4.16,32,,,percent of total billed charges,32% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,8.71,67,,,percent of total billed charges,67% of total billed charges,8.71,67,,,percent of total billed charges,67% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,9.88,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,4.28,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,11.7,90,,,percent of total billed charges,90% of total billed charges,11.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,11.52,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,4.16,32,,,percent of total billed charges,32% of total billed charges,10.4,80,,,percent of total billed charges,80% of total billed charges,10.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,11.83,91,,,percent of total billed charges,91% of total billed charges,4.24,32.64,,,percent of total billed charges,32.64% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,4.37,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,4.16,32,,,percent of total billed charges,32% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,11.96,92,,,percent of total billed charges,92% of total billed charges,4.16,11.96,
NUCLEIC ACID 1ST 2,2000644,CDM,301,RC,,,Outpatient,,,13,11.05,,10.56,81.2,,,percent of total billed charges,81.2% of total billed charges,4.24,32.64,,,percent of total billed charges,32.64% of total billed charges,9.62,74,,,percent of total billed charges,74% of total billed charges,9.62,74,,,percent of total billed charges,74% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,4.16,32,,,percent of total billed charges,32% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,8.71,67,,,percent of total billed charges,67% of total billed charges,8.71,67,,,percent of total billed charges,67% of total billed charges,9.23,71,,,percent of total billed charges,71% of total billed charges,9.88,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,4.28,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,11.7,90,,,percent of total billed charges,90% of total billed charges,11.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,11.52,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,4.16,32,,,percent of total billed charges,32% of total billed charges,10.4,80,,,percent of total billed charges,80% of total billed charges,10.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,11.83,91,,,percent of total billed charges,91% of total billed charges,4.24,32.64,,,percent of total billed charges,32.64% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,4.37,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,4.16,32,,,percent of total billed charges,32% of total billed charges,4.16,32,,,percent of total billed charges,32% of total billed charges,11.96,92,,,percent of total billed charges,92% of total billed charges,4.16,11.96,
ALLERGEN NUT PANEL,2001701,CDM,300,RC,,,Outpatient,,,34,28.9,,27.61,81.2,,,percent of total billed charges,81.2% of total billed charges,11.1,32.64,,,percent of total billed charges,32.64% of total billed charges,25.16,74,,,percent of total billed charges,74% of total billed charges,25.16,74,,,percent of total billed charges,74% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,10.88,32,,,percent of total billed charges,32% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,22.78,67,,,percent of total billed charges,67% of total billed charges,22.78,67,,,percent of total billed charges,67% of total billed charges,24.14,71,,,percent of total billed charges,71% of total billed charges,25.84,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,11.21,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,30.6,90,,,percent of total billed charges,90% of total billed charges,30.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,30.12,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,10.88,32,,,percent of total billed charges,32% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,27.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,30.94,91,,,percent of total billed charges,91% of total billed charges,11.1,32.64,,,percent of total billed charges,32.64% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,11.42,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,10.88,32,,,percent of total billed charges,32% of total billed charges,10.88,32,,,percent of total billed charges,32% of total billed charges,31.28,92,,,percent of total billed charges,92% of total billed charges,10.88,31.28,
MOLECULAR DIAG EXTRACTION,2000471,CDM,301,RC,,,Outpatient,,,36,30.6,,29.23,81.2,,,percent of total billed charges,81.2% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,26.64,74,,,percent of total billed charges,74% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,11.52,32,,,percent of total billed charges,32% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,24.12,67,,,percent of total billed charges,67% of total billed charges,25.56,71,,,percent of total billed charges,71% of total billed charges,27.36,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,11.87,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,32.4,90,,,percent of total billed charges,90% of total billed charges,32.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,31.9,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,11.52,32,,,percent of total billed charges,32% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,28.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,32.76,91,,,percent of total billed charges,91% of total billed charges,11.75,32.64,,,percent of total billed charges,32.64% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,12.1,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,11.52,32,,,percent of total billed charges,32% of total billed charges,11.52,32,,,percent of total billed charges,32% of total billed charges,33.12,92,,,percent of total billed charges,92% of total billed charges,11.52,33.12,
INTERPRETATION AND REPORT,2000971,CDM,300,RC,,,Outpatient,,,50,42.5,,40.6,81.2,,,percent of total billed charges,81.2% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,37,74,,,percent of total billed charges,74% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,16,32,,,percent of total billed charges,32% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,33.5,67,,,percent of total billed charges,67% of total billed charges,35.5,71,,,percent of total billed charges,71% of total billed charges,38,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,16.48,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,44.3,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,16,32,,,percent of total billed charges,32% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,40,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,45.5,91,,,percent of total billed charges,91% of total billed charges,16.32,32.64,,,percent of total billed charges,32.64% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,16.8,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,16,32,,,percent of total billed charges,32% of total billed charges,16,32,,,percent of total billed charges,32% of total billed charges,46,92,,,percent of total billed charges,92% of total billed charges,16,46,
MOLECULAR DIAG AMPLIFICATION,2000474,CDM,301,RC,,,Outpatient,,,106,90.1,,86.07,81.2,,,percent of total billed charges,81.2% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,78.44,74,,,percent of total billed charges,74% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,33.92,32,,,percent of total billed charges,32% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,71.02,67,,,percent of total billed charges,67% of total billed charges,75.26,71,,,percent of total billed charges,71% of total billed charges,80.56,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,34.94,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,93.92,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,33.92,32,,,percent of total billed charges,32% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,84.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,96.46,91,,,percent of total billed charges,91% of total billed charges,34.6,32.64,,,percent of total billed charges,32.64% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,35.62,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,33.92,32,,,percent of total billed charges,32% of total billed charges,33.92,32,,,percent of total billed charges,32% of total billed charges,97.52,92,,,percent of total billed charges,92% of total billed charges,33.92,97.52,
OXYCODONE QUANT SERUM W/CONFI,2000826,CDM,300,RC,,,Outpatient,,,325,276.25,,263.9,81.2,,,percent of total billed charges,81.2% of total billed charges,106.08,32.64,,,percent of total billed charges,32.64% of total billed charges,240.5,74,,,percent of total billed charges,74% of total billed charges,240.5,74,,,percent of total billed charges,74% of total billed charges,104,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,104,32,,,percent of total billed charges,32% of total billed charges,230.75,71,,,percent of total billed charges,71% of total billed charges,230.75,71,,,percent of total billed charges,71% of total billed charges,217.75,67,,,percent of total billed charges,67% of total billed charges,217.75,67,,,percent of total billed charges,67% of total billed charges,230.75,71,,,percent of total billed charges,71% of total billed charges,247,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,107.12,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,292.5,90,,,percent of total billed charges,90% of total billed charges,292.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,287.95,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,104,32,,,percent of total billed charges,32% of total billed charges,260,80,,,percent of total billed charges,80% of total billed charges,260,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,295.75,91,,,percent of total billed charges,91% of total billed charges,106.08,32.64,,,percent of total billed charges,32.64% of total billed charges,104,32,,,percent of total billed charges,32% of total billed charges,109.2,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,104,32,,,percent of total billed charges,32% of total billed charges,104,32,,,percent of total billed charges,32% of total billed charges,299,92,,,percent of total billed charges,92% of total billed charges,104,299,
TOX ASSURE SELECT PROFILE,2001486,CDM,301,RC,,,Outpatient,,,633,538.05,,514,81.2,,,percent of total billed charges,81.2% of total billed charges,206.61,32.64,,,percent of total billed charges,32.64% of total billed charges,468.42,74,,,percent of total billed charges,74% of total billed charges,468.42,74,,,percent of total billed charges,74% of total billed charges,202.56,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,202.56,32,,,percent of total billed charges,32% of total billed charges,449.43,71,,,percent of total billed charges,71% of total billed charges,449.43,71,,,percent of total billed charges,71% of total billed charges,424.11,67,,,percent of total billed charges,67% of total billed charges,424.11,67,,,percent of total billed charges,67% of total billed charges,449.43,71,,,percent of total billed charges,71% of total billed charges,481.08,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,208.64,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,569.7,90,,,percent of total billed charges,90% of total billed charges,569.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,560.84,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,202.56,32,,,percent of total billed charges,32% of total billed charges,506.4,80,,,percent of total billed charges,80% of total billed charges,506.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,576.03,91,,,percent of total billed charges,91% of total billed charges,206.61,32.64,,,percent of total billed charges,32.64% of total billed charges,202.56,32,,,percent of total billed charges,32% of total billed charges,212.69,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,202.56,32,,,percent of total billed charges,32% of total billed charges,202.56,32,,,percent of total billed charges,32% of total billed charges,582.36,92,,,percent of total billed charges,92% of total billed charges,202.56,582.36,
THROMBIC RISK PROFILE COMPREHENSIVE,2001175,CDM,300,RC,,,Outpatient,,,3310,2813.5,,2687.72,81.2,,,percent of total billed charges,81.2% of total billed charges,1080.38,32.64,,,percent of total billed charges,32.64% of total billed charges,2449.4,74,,,percent of total billed charges,74% of total billed charges,2449.4,74,,,percent of total billed charges,74% of total billed charges,1059.2,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,1059.2,32,,,percent of total billed charges,32% of total billed charges,2350.1,71,,,percent of total billed charges,71% of total billed charges,2350.1,71,,,percent of total billed charges,71% of total billed charges,2217.7,67,,,percent of total billed charges,67% of total billed charges,2217.7,67,,,percent of total billed charges,67% of total billed charges,2350.1,71,,,percent of total billed charges,71% of total billed charges,2515.6,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,1090.98,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,2979,90,,,percent of total billed charges,90% of total billed charges,2979,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,2932.66,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,1059.2,32,,,percent of total billed charges,32% of total billed charges,2648,80,,,percent of total billed charges,80% of total billed charges,2648,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,3012.1,91,,,percent of total billed charges,91% of total billed charges,1080.38,32.64,,,percent of total billed charges,32.64% of total billed charges,1059.2,32,,,percent of total billed charges,32% of total billed charges,1112.16,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,1059.2,32,,,percent of total billed charges,32% of total billed charges,1059.2,32,,,percent of total billed charges,32% of total billed charges,3045.2,92,,,percent of total billed charges,92% of total billed charges,1059.2,3045.2,
MAMMO BREAST NL LT--INITIAL LESION,4300007,CDM,401,RC,19281,HCPCS,Outpatient,,,504,428.4,,409.25,81.2,,,percent of total billed charges,81.2% of total billed charges,164.51,32.64,,,percent of total billed charges,32.64% of total billed charges,372.96,74,,,percent of total billed charges,74% of total billed charges,372.96,74,,,percent of total billed charges,74% of total billed charges,161.28,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,161.28,32,,,percent of total billed charges,32% of total billed charges,357.84,71,,,percent of total billed charges,71% of total billed charges,357.84,71,,,percent of total billed charges,71% of total billed charges,337.68,67,,,percent of total billed charges,67% of total billed charges,337.68,67,,,percent of total billed charges,67% of total billed charges,357.84,71,,,percent of total billed charges,71% of total billed charges,383.04,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,166.12,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,453.6,90,,,percent of total billed charges,90% of total billed charges,453.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,446.54,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,161.28,32,,,percent of total billed charges,32% of total billed charges,403.2,80,,,percent of total billed charges,80% of total billed charges,403.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,458.64,91,,,percent of total billed charges,91% of total billed charges,164.51,32.64,,,percent of total billed charges,32.64% of total billed charges,161.28,32,,,percent of total billed charges,32% of total billed charges,169.34,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,161.28,32,,,percent of total billed charges,32% of total billed charges,161.28,32,,,percent of total billed charges,32% of total billed charges,463.68,92,,,percent of total billed charges,92% of total billed charges,161.28,463.68,
MAMMO BREAST NL RT-INITIAL LESION,4300008,CDM,401,RC,19281,HCPCS,Outpatient,,,504,428.4,,409.25,81.2,,,percent of total billed charges,81.2% of total billed charges,164.51,32.64,,,percent of total billed charges,32.64% of total billed charges,372.96,74,,,percent of total billed charges,74% of total billed charges,372.96,74,,,percent of total billed charges,74% of total billed charges,161.28,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,161.28,32,,,percent of total billed charges,32% of total billed charges,357.84,71,,,percent of total billed charges,71% of total billed charges,357.84,71,,,percent of total billed charges,71% of total billed charges,337.68,67,,,percent of total billed charges,67% of total billed charges,337.68,67,,,percent of total billed charges,67% of total billed charges,357.84,71,,,percent of total billed charges,71% of total billed charges,383.04,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,166.12,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,453.6,90,,,percent of total billed charges,90% of total billed charges,453.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,446.54,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,161.28,32,,,percent of total billed charges,32% of total billed charges,403.2,80,,,percent of total billed charges,80% of total billed charges,403.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,458.64,91,,,percent of total billed charges,91% of total billed charges,164.51,32.64,,,percent of total billed charges,32.64% of total billed charges,161.28,32,,,percent of total billed charges,32% of total billed charges,169.34,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,161.28,32,,,percent of total billed charges,32% of total billed charges,161.28,32,,,percent of total billed charges,32% of total billed charges,463.68,92,,,percent of total billed charges,92% of total billed charges,161.28,463.68,
MAMMO BILAT BREAST NL--INITIAL LESION,4300012,CDM,401,RC,19281,HCPCS,Outpatient,,,756,642.6,,613.87,81.2,,,percent of total billed charges,81.2% of total billed charges,246.76,32.64,,,percent of total billed charges,32.64% of total billed charges,559.44,74,,,percent of total billed charges,74% of total billed charges,559.44,74,,,percent of total billed charges,74% of total billed charges,241.92,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,241.92,32,,,percent of total billed charges,32% of total billed charges,536.76,71,,,percent of total billed charges,71% of total billed charges,536.76,71,,,percent of total billed charges,71% of total billed charges,506.52,67,,,percent of total billed charges,67% of total billed charges,506.52,67,,,percent of total billed charges,67% of total billed charges,536.76,71,,,percent of total billed charges,71% of total billed charges,574.56,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,249.18,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,680.4,90,,,percent of total billed charges,90% of total billed charges,680.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,669.82,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,241.92,32,,,percent of total billed charges,32% of total billed charges,604.8,80,,,percent of total billed charges,80% of total billed charges,604.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,687.96,91,,,percent of total billed charges,91% of total billed charges,246.76,32.64,,,percent of total billed charges,32.64% of total billed charges,241.92,32,,,percent of total billed charges,32% of total billed charges,254.02,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,241.92,32,,,percent of total billed charges,32% of total billed charges,241.92,32,,,percent of total billed charges,32% of total billed charges,695.52,92,,,percent of total billed charges,92% of total billed charges,241.92,695.52,
MAMMO BREAST NL --ADDITIONAL LESION,4300044,CDM,401,RC,19282,HCPCS,Outpatient,,,504,428.4,,409.25,81.2,,,percent of total billed charges,81.2% of total billed charges,164.51,32.64,,,percent of total billed charges,32.64% of total billed charges,372.96,74,,,percent of total billed charges,74% of total billed charges,372.96,74,,,percent of total billed charges,74% of total billed charges,161.28,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,161.28,32,,,percent of total billed charges,32% of total billed charges,357.84,71,,,percent of total billed charges,71% of total billed charges,357.84,71,,,percent of total billed charges,71% of total billed charges,337.68,67,,,percent of total billed charges,67% of total billed charges,337.68,67,,,percent of total billed charges,67% of total billed charges,357.84,71,,,percent of total billed charges,71% of total billed charges,383.04,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,166.12,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,453.6,90,,,percent of total billed charges,90% of total billed charges,453.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,446.54,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,161.28,32,,,percent of total billed charges,32% of total billed charges,403.2,80,,,percent of total billed charges,80% of total billed charges,403.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,458.64,91,,,percent of total billed charges,91% of total billed charges,164.51,32.64,,,percent of total billed charges,32.64% of total billed charges,161.28,32,,,percent of total billed charges,32% of total billed charges,169.34,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,161.28,32,,,percent of total billed charges,32% of total billed charges,161.28,32,,,percent of total billed charges,32% of total billed charges,463.68,92,,,percent of total billed charges,92% of total billed charges,161.28,463.68,
MAMMO BR XR TISSUE SPEC,4300004,CDM,320,RC,76098,HCPCS,Outpatient,,,137,116.45,,111.24,81.2,,,percent of total billed charges,81.2% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,104.12,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,45.16,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,121.38,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,124.67,91,,,percent of total billed charges,91% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,46.03,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,126.04,92,,,percent of total billed charges,92% of total billed charges,43.84,126.04,
MAMMO TOMO DIAG LT,4300051,CDM,401,RC,77061,HCPCS,Outpatient,,,88,74.8,,71.46,81.2,,,percent of total billed charges,81.2% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,66.88,76,,,percent of total billed charges,76% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,29,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,77.97,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,80.08,91,,,percent of total billed charges,91% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,29.57,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,80.96,92,,,percent of total billed charges,92% of total billed charges,28.16,80.96,
MAMMO TOMO DIAG RT,4300050,CDM,401,RC,77061,HCPCS,Outpatient,,,88,74.8,,71.46,81.2,,,percent of total billed charges,81.2% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,66.88,76,,,percent of total billed charges,76% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,29,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,77.97,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,80.08,91,,,percent of total billed charges,91% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,29.57,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,80.96,92,,,percent of total billed charges,92% of total billed charges,28.16,80.96,
MAMMO TOMO DIAG BILAT,4300052,CDM,401,RC,77062,HCPCS,Outpatient,,,88,74.8,,71.46,81.2,,,percent of total billed charges,81.2% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,66.88,76,,,percent of total billed charges,76% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,29,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,77.97,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,80.08,91,,,percent of total billed charges,91% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,29.57,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,80.96,92,,,percent of total billed charges,92% of total billed charges,28.16,80.96,
MAMMO TOMO SCREEN BILAT,4300053,CDM,403,RC,77063,HCPCS,Outpatient,,,88,74.8,,71.46,81.2,,,percent of total billed charges,81.2% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,66.88,76,,,percent of total billed charges,76% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,29,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,77.97,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,80.08,91,,,percent of total billed charges,91% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,29.57,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,80.96,92,,,percent of total billed charges,92% of total billed charges,28.16,80.96,
MAMMO TOMO SCREEN LT,4300055,CDM,403,RC,77063,HCPCS,Outpatient,,,88,74.8,,71.46,81.2,,,percent of total billed charges,81.2% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,66.88,76,,,percent of total billed charges,76% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,29,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,77.97,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,80.08,91,,,percent of total billed charges,91% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,29.57,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,80.96,92,,,percent of total billed charges,92% of total billed charges,28.16,80.96,
MAMMO TOMO SCREEN RT,4300054,CDM,403,RC,77063,HCPCS,Outpatient,,,88,74.8,,71.46,81.2,,,percent of total billed charges,81.2% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,65.12,74,,,percent of total billed charges,74% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,58.96,67,,,percent of total billed charges,67% of total billed charges,62.48,71,,,percent of total billed charges,71% of total billed charges,66.88,76,,,percent of total billed charges,76% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,29,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,77.97,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,70.4,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,80.08,91,,,percent of total billed charges,91% of total billed charges,28.72,32.64,,,percent of total billed charges,32.64% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,29.57,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,28.16,32,,,percent of total billed charges,32% of total billed charges,28.16,32,,,percent of total billed charges,32% of total billed charges,80.96,92,,,percent of total billed charges,92% of total billed charges,28.16,80.96,
MAMMO DIG 2V LT,4300035,CDM,401,RC,77065,HCPCS,Outpatient,,,234,198.9,,190.01,81.2,,,percent of total billed charges,81.2% of total billed charges,76.38,32.64,,,percent of total billed charges,32.64% of total billed charges,196,100,,,Case rate,Pays based on per visit,196,100,,,Case rate,Pays based on per visit,74.88,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,74.88,32,,,percent of total billed charges,32% of total billed charges,186,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,177.84,100,,,Case rate,pays based on per visit,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.13,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,210.6,90,,,percent of total billed charges,90% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,207.32,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,74.88,32,,,percent of total billed charges,32% of total billed charges,187.2,80,,,percent of total billed charges,80% of total billed charges,187.2,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,212.94,91,,,percent of total billed charges,91% of total billed charges,76.38,32.64,,,percent of total billed charges,32.64% of total billed charges,74.88,32,,,percent of total billed charges,32% of total billed charges,78.62,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,74.88,32,,,percent of total billed charges,32% of total billed charges,74.88,32,,,percent of total billed charges,32% of total billed charges,215.28,92,,,percent of total billed charges,92% of total billed charges,31.93,215.28,
MAMMO DIG 2V RT,4300036,CDM,401,RC,77065,HCPCS,Outpatient,,,234,198.9,,190.01,81.2,,,percent of total billed charges,81.2% of total billed charges,76.38,32.64,,,percent of total billed charges,32.64% of total billed charges,196,100,,,Case rate,Pays based on per visit,196,100,,,Case rate,Pays based on per visit,74.88,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,74.88,32,,,percent of total billed charges,32% of total billed charges,186,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,177.84,100,,,Case rate,pays based on per visit,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.13,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,210.6,90,,,percent of total billed charges,90% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,207.32,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,74.88,32,,,percent of total billed charges,32% of total billed charges,187.2,80,,,percent of total billed charges,80% of total billed charges,187.2,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,212.94,91,,,percent of total billed charges,91% of total billed charges,76.38,32.64,,,percent of total billed charges,32.64% of total billed charges,74.88,32,,,percent of total billed charges,32% of total billed charges,78.62,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,74.88,32,,,percent of total billed charges,32% of total billed charges,74.88,32,,,percent of total billed charges,32% of total billed charges,215.28,92,,,percent of total billed charges,92% of total billed charges,31.93,215.28,
MAMMO DIG DIAG BILAT,4300037,CDM,401,RC,77066,HCPCS,Outpatient,,,387,328.95,,314.24,81.2,,,percent of total billed charges,81.2% of total billed charges,126.32,32.64,,,percent of total billed charges,32.64% of total billed charges,196,100,,,Case rate,Pays based on per visit,196,100,,,Case rate,Pays based on per visit,123.84,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,123.84,32,,,percent of total billed charges,32% of total billed charges,186,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,294.12,100,,,Case rate,pays based on per visit,32.89,103,,,Fee Schedule,pays based on EAPG rates,127.56,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,348.3,90,,,percent of total billed charges,90% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,342.88,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,123.84,32,,,percent of total billed charges,32% of total billed charges,309.6,80,,,percent of total billed charges,80% of total billed charges,309.6,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,352.17,91,,,percent of total billed charges,91% of total billed charges,126.32,32.64,,,percent of total billed charges,32.64% of total billed charges,123.84,32,,,percent of total billed charges,32% of total billed charges,130.03,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,123.84,32,,,percent of total billed charges,32% of total billed charges,123.84,32,,,percent of total billed charges,32% of total billed charges,356.04,92,,,percent of total billed charges,92% of total billed charges,31.93,356.04,
MAMMO DIG SC MAST LT,4300042,CDM,403,RC,77067,HCPCS,Outpatient,,,241,204.85,,195.69,81.2,,,percent of total billed charges,81.2% of total billed charges,78.66,32.64,,,percent of total billed charges,32.64% of total billed charges,196,100,,,Case rate,Pays based on per visit,196,100,,,Case rate,Pays based on per visit,77.12,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,186,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,183.16,100,,,Case rate,pays based on per visit,32.89,103,,,Fee Schedule,pays based on EAPG rates,79.43,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,213.53,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,192.8,80,,,percent of total billed charges,80% of total billed charges,192.8,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,219.31,91,,,percent of total billed charges,91% of total billed charges,78.66,32.64,,,percent of total billed charges,32.64% of total billed charges,77.12,32,,,percent of total billed charges,32% of total billed charges,80.98,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,77.12,32,,,percent of total billed charges,32% of total billed charges,221.72,92,,,percent of total billed charges,92% of total billed charges,31.93,221.72,
MAMMO DIG SC MAST RT,4300043,CDM,403,RC,77067,HCPCS,Outpatient,,,241,204.85,,195.69,81.2,,,percent of total billed charges,81.2% of total billed charges,78.66,32.64,,,percent of total billed charges,32.64% of total billed charges,196,100,,,Case rate,Pays based on per visit,196,100,,,Case rate,Pays based on per visit,77.12,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,186,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,183.16,100,,,Case rate,pays based on per visit,32.89,103,,,Fee Schedule,pays based on EAPG rates,79.43,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,213.53,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,192.8,80,,,percent of total billed charges,80% of total billed charges,192.8,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,219.31,91,,,percent of total billed charges,91% of total billed charges,78.66,32.64,,,percent of total billed charges,32.64% of total billed charges,77.12,32,,,percent of total billed charges,32% of total billed charges,80.98,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,77.12,32,,,percent of total billed charges,32% of total billed charges,221.72,92,,,percent of total billed charges,92% of total billed charges,31.93,221.72,
MAMMO DIG SCREEN 4V,4300038,CDM,403,RC,77067,HCPCS,Outpatient,,,241,204.85,,195.69,81.2,,,percent of total billed charges,81.2% of total billed charges,78.66,32.64,,,percent of total billed charges,32.64% of total billed charges,196,100,,,Case rate,Pays based on per visit,196,100,,,Case rate,Pays based on per visit,77.12,32,,,percent of total billed charges,32% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,186,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,177,100,,,Case rate,pays based on per visit,186,100,,,Case rate,pays based on per visit,183.16,100,,,Case rate,pays based on per visit,32.89,103,,,Fee Schedule,pays based on EAPG rates,79.43,32.96,,,percent of total billed charges,32.96% of total billed charges,33.53,105,,,Fee Schedule,pays based on EAPG rates,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,213.53,88.6,,,percent of total billed charges,88.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,192.8,80,,,percent of total billed charges,80% of total billed charges,192.8,80,,,percent of total billed charges,80% of total billed charges,31.93,100,,,Fee Schedule,pays based on EAPG rates,219.31,91,,,percent of total billed charges,91% of total billed charges,78.66,32.64,,,percent of total billed charges,32.64% of total billed charges,77.12,32,,,percent of total billed charges,32% of total billed charges,80.98,33.6,,,percent of total billed charges,33.6% of total billed charges,32.89,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,77.12,32,,,percent of total billed charges,32% of total billed charges,221.72,92,,,percent of total billed charges,92% of total billed charges,31.93,221.72,
PLATELET/PLASMA TRANSFUSION 1 10 UNIT,100016,CDM,391,RC,36430,HCPCS,Outpatient,,,501,425.85,,406.81,81.2,,,percent of total billed charges,81.2% of total billed charges,163.53,32.64,,,percent of total billed charges,32.64% of total billed charges,370.74,74,,,percent of total billed charges,74% of total billed charges,370.74,74,,,percent of total billed charges,74% of total billed charges,160.32,32,,,percent of total billed charges,32% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,160.32,32,,,percent of total billed charges,32% of total billed charges,355.71,71,,,percent of total billed charges,71% of total billed charges,355.71,71,,,percent of total billed charges,71% of total billed charges,335.67,67,,,percent of total billed charges,67% of total billed charges,335.67,67,,,percent of total billed charges,67% of total billed charges,355.71,71,,,percent of total billed charges,71% of total billed charges,380.76,76,,,percent of total billed charges,76% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,165.13,32.96,,,percent of total billed charges,32.96% of total billed charges,293.63,105,,,Fee Schedule,pays based on EAPG rates,450.9,90,,,percent of total billed charges,90% of total billed charges,450.9,90,,,percent of total billed charges,90% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,443.89,88.6,,,percent of total billed charges,88.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,160.32,32,,,percent of total billed charges,32% of total billed charges,400.8,80,,,percent of total billed charges,80% of total billed charges,400.8,80,,,percent of total billed charges,80% of total billed charges,279.65,100,,,Fee Schedule,pays based on EAPG rates,455.91,91,,,percent of total billed charges,91% of total billed charges,163.53,32.64,,,percent of total billed charges,32.64% of total billed charges,160.32,32,,,percent of total billed charges,32% of total billed charges,168.34,33.6,,,percent of total billed charges,33.6% of total billed charges,288.04,103,,,Fee Schedule,pays based on EAPG rates,160.32,32,,,percent of total billed charges,32% of total billed charges,160.32,32,,,percent of total billed charges,32% of total billed charges,460.92,92,,,percent of total billed charges,92% of total billed charges,160.32,460.92,
CENTRAL LINE PLACEMENT,100007,CDM,270,RC,36556,HCPCS,Outpatient,,,1283,1090.55,,1041.8,81.2,,,percent of total billed charges,81.2% of total billed charges,418.77,32.64,,,percent of total billed charges,32.64% of total billed charges,949.42,74,,,percent of total billed charges,74% of total billed charges,949.42,74,,,percent of total billed charges,74% of total billed charges,410.56,32,,,percent of total billed charges,32% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,410.56,32,,,percent of total billed charges,32% of total billed charges,910.93,71,,,percent of total billed charges,71% of total billed charges,910.93,71,,,percent of total billed charges,71% of total billed charges,859.61,67,,,percent of total billed charges,67% of total billed charges,859.61,67,,,percent of total billed charges,67% of total billed charges,910.93,71,,,percent of total billed charges,71% of total billed charges,975.08,76,,,percent of total billed charges,76% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,422.88,32.96,,,percent of total billed charges,32.96% of total billed charges,497.73,105,,,Fee Schedule,pays based on EAPG rates,1154.7,90,,,percent of total billed charges,90% of total billed charges,1154.7,90,,,percent of total billed charges,90% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,1136.74,88.6,,,percent of total billed charges,88.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,410.56,32,,,percent of total billed charges,32% of total billed charges,1026.4,80,,,percent of total billed charges,80% of total billed charges,1026.4,80,,,percent of total billed charges,80% of total billed charges,474.03,100,,,Fee Schedule,pays based on EAPG rates,1167.53,91,,,percent of total billed charges,91% of total billed charges,418.77,32.64,,,percent of total billed charges,32.64% of total billed charges,410.56,32,,,percent of total billed charges,32% of total billed charges,431.09,33.6,,,percent of total billed charges,33.6% of total billed charges,488.25,103,,,Fee Schedule,pays based on EAPG rates,410.56,32,,,percent of total billed charges,32% of total billed charges,410.56,32,,,percent of total billed charges,32% of total billed charges,1180.36,92,,,percent of total billed charges,92% of total billed charges,410.56,1180.36,
BLADDER SCAN,100067,CDM,761,RC,51798,HCPCS,Outpatient,,,66,56.1,,53.59,81.2,,,percent of total billed charges,81.2% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,48.84,74,,,percent of total billed charges,74% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,44.22,67,,,percent of total billed charges,67% of total billed charges,46.86,71,,,percent of total billed charges,71% of total billed charges,50.16,76,,,percent of total billed charges,76% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,21.75,32.96,,,percent of total billed charges,32.96% of total billed charges,32.13,105,,,Fee Schedule,pays based on EAPG rates,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,58.48,88.6,,,percent of total billed charges,88.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,52.8,80,,,percent of total billed charges,80% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,60.06,91,,,percent of total billed charges,91% of total billed charges,21.54,32.64,,,percent of total billed charges,32.64% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,22.18,33.6,,,percent of total billed charges,33.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,21.12,32,,,percent of total billed charges,32% of total billed charges,21.12,32,,,percent of total billed charges,32% of total billed charges,60.72,92,,,percent of total billed charges,92% of total billed charges,21.12,60.72,
ADMINISTRATION FLU VACCINE,100024,CDM,771,RC,90471,HCPCS,Outpatient,,,42,35.7,,34.1,81.2,,,percent of total billed charges,81.2% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,31.92,76,,,percent of total billed charges,76% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.84,32.96,,,percent of total billed charges,32.96% of total billed charges,11.05,105,,,Fee Schedule,pays based on EAPG rates,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,10.52,100,,,Fee Schedule,pays based on EAPG rates,37.21,88.6,,,percent of total billed charges,88.6% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.52,100,,,Fee Schedule,pays based on EAPG rates,38.22,91,,,percent of total billed charges,91% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,14.11,33.6,,,percent of total billed charges,33.6% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,38.64,92,,,percent of total billed charges,92% of total billed charges,10.52,38.64,
ADMINISTRATION PNEUMONIA VACCI,100025,CDM,771,RC,90471,HCPCS,Outpatient,,,42,35.7,,34.1,81.2,,,percent of total billed charges,81.2% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,31.08,74,,,percent of total billed charges,74% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,28.14,67,,,percent of total billed charges,67% of total billed charges,29.82,71,,,percent of total billed charges,71% of total billed charges,31.92,76,,,percent of total billed charges,76% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.84,32.96,,,percent of total billed charges,32.96% of total billed charges,11.05,105,,,Fee Schedule,pays based on EAPG rates,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,10.52,100,,,Fee Schedule,pays based on EAPG rates,37.21,88.6,,,percent of total billed charges,88.6% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,33.6,80,,,percent of total billed charges,80% of total billed charges,10.52,100,,,Fee Schedule,pays based on EAPG rates,38.22,91,,,percent of total billed charges,91% of total billed charges,13.71,32.64,,,percent of total billed charges,32.64% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,14.11,33.6,,,percent of total billed charges,33.6% of total billed charges,10.84,103,,,Fee Schedule,pays based on EAPG rates,13.44,32,,,percent of total billed charges,32% of total billed charges,13.44,32,,,percent of total billed charges,32% of total billed charges,38.64,92,,,percent of total billed charges,92% of total billed charges,10.52,38.64,
LEVEL 1 VISIT EST PATIENT,100037,CDM,510,RC,99211,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,39.04,112.24,
OBSERVATION PER HOUR,100048,CDM,762,RC,G0378,HCPCS,Outpatient,,,51,43.35,,41.41,81.2,,,percent of total billed charges,81.2% of total billed charges,16.65,32.64,,,percent of total billed charges,32.64% of total billed charges,37.74,74,,,percent of total billed charges,74% of total billed charges,37.74,74,,,percent of total billed charges,74% of total billed charges,16.32,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,16.32,32,,,percent of total billed charges,32% of total billed charges,36.21,71,,,percent of total billed charges,71% of total billed charges,36.21,71,,,percent of total billed charges,71% of total billed charges,34.17,67,,,percent of total billed charges,67% of total billed charges,34.17,67,,,percent of total billed charges,67% of total billed charges,36.21,71,,,percent of total billed charges,71% of total billed charges,38.76,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,16.81,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,45.9,90,,,percent of total billed charges,90% of total billed charges,45.9,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,45.19,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,16.32,32,,,percent of total billed charges,32% of total billed charges,40.8,80,,,percent of total billed charges,80% of total billed charges,40.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,46.41,91,,,percent of total billed charges,91% of total billed charges,16.65,32.64,,,percent of total billed charges,32.64% of total billed charges,16.32,32,,,percent of total billed charges,32% of total billed charges,22.29,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,16.32,32,,,percent of total billed charges,32% of total billed charges,16.32,32,,,percent of total billed charges,32% of total billed charges,46.92,92,,,percent of total billed charges,92% of total billed charges,16.32,46.92,
RECOVERY OUTPT 1   2 HRS,100044,CDM,710,RC,,,Outpatient,,,277,235.45,,224.92,81.2,,,percent of total billed charges,81.2% of total billed charges,90.41,32.64,,,percent of total billed charges,32.64% of total billed charges,204.98,74,,,percent of total billed charges,74% of total billed charges,204.98,74,,,percent of total billed charges,74% of total billed charges,88.64,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,88.64,32,,,percent of total billed charges,32% of total billed charges,196.67,71,,,percent of total billed charges,71% of total billed charges,196.67,71,,,percent of total billed charges,71% of total billed charges,185.59,67,,,percent of total billed charges,67% of total billed charges,185.59,67,,,percent of total billed charges,67% of total billed charges,196.67,71,,,percent of total billed charges,71% of total billed charges,210.52,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,91.3,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,249.3,90,,,percent of total billed charges,90% of total billed charges,249.3,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,245.42,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,88.64,32,,,percent of total billed charges,32% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,221.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,252.07,91,,,percent of total billed charges,91% of total billed charges,90.41,32.64,,,percent of total billed charges,32.64% of total billed charges,88.64,32,,,percent of total billed charges,32% of total billed charges,93.07,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,88.64,32,,,percent of total billed charges,32% of total billed charges,88.64,32,,,percent of total billed charges,32% of total billed charges,254.84,92,,,percent of total billed charges,92% of total billed charges,88.64,254.84,
RECOVERY OUTPT 3   5 HRS,100045,CDM,710,RC,,,Outpatient,,,465,395.25,,377.58,81.2,,,percent of total billed charges,81.2% of total billed charges,151.78,32.64,,,percent of total billed charges,32.64% of total billed charges,344.1,74,,,percent of total billed charges,74% of total billed charges,344.1,74,,,percent of total billed charges,74% of total billed charges,148.8,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,148.8,32,,,percent of total billed charges,32% of total billed charges,330.15,71,,,percent of total billed charges,71% of total billed charges,330.15,71,,,percent of total billed charges,71% of total billed charges,311.55,67,,,percent of total billed charges,67% of total billed charges,311.55,67,,,percent of total billed charges,67% of total billed charges,330.15,71,,,percent of total billed charges,71% of total billed charges,353.4,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,153.26,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,418.5,90,,,percent of total billed charges,90% of total billed charges,418.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,411.99,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,148.8,32,,,percent of total billed charges,32% of total billed charges,372,80,,,percent of total billed charges,80% of total billed charges,372,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,423.15,91,,,percent of total billed charges,91% of total billed charges,151.78,32.64,,,percent of total billed charges,32.64% of total billed charges,148.8,32,,,percent of total billed charges,32% of total billed charges,156.24,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,148.8,32,,,percent of total billed charges,32% of total billed charges,148.8,32,,,percent of total billed charges,32% of total billed charges,427.8,92,,,percent of total billed charges,92% of total billed charges,148.8,427.8,
RECOVERY OUTPT 6+ HOURS,100046,CDM,710,RC,,,Outpatient,,,559,475.15,,453.91,81.2,,,percent of total billed charges,81.2% of total billed charges,182.46,32.64,,,percent of total billed charges,32.64% of total billed charges,413.66,74,,,percent of total billed charges,74% of total billed charges,413.66,74,,,percent of total billed charges,74% of total billed charges,178.88,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,178.88,32,,,percent of total billed charges,32% of total billed charges,396.89,71,,,percent of total billed charges,71% of total billed charges,396.89,71,,,percent of total billed charges,71% of total billed charges,374.53,67,,,percent of total billed charges,67% of total billed charges,374.53,67,,,percent of total billed charges,67% of total billed charges,396.89,71,,,percent of total billed charges,71% of total billed charges,424.84,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,184.25,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,503.1,90,,,percent of total billed charges,90% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,495.27,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,178.88,32,,,percent of total billed charges,32% of total billed charges,447.2,80,,,percent of total billed charges,80% of total billed charges,447.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,508.69,91,,,percent of total billed charges,91% of total billed charges,182.46,32.64,,,percent of total billed charges,32.64% of total billed charges,178.88,32,,,percent of total billed charges,32% of total billed charges,187.82,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,178.88,32,,,percent of total billed charges,32% of total billed charges,178.88,32,,,percent of total billed charges,32% of total billed charges,514.28,92,,,percent of total billed charges,92% of total billed charges,178.88,514.28,
MRI TMJ,4600011,CDM,614,RC,70336,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
"MRI ORB,FACE,NK W/O",4600012,CDM,614,RC,70540,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
"MRI ORB,FACE,NK W/",4600222,CDM,614,RC,70542,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
"MRI ORB,FACE,NK W/WO",4600087,CDM,614,RC,70543,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRA BRAIN W/O,4600066,CDM,615,RC,70544,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRV BRAIN W/O,4600098,CDM,615,RC,70544,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA BRAIN W/,4600043,CDM,615,RC,70545,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA BRAIN W/WO,4600067,CDM,615,RC,70546,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRV BRAIN W/WO,4600218,CDM,615,RC,70546,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA NECK W/O,4600068,CDM,615,RC,70547,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA NECK W/,4600042,CDM,615,RC,70548,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA NECK W/WO,4600091,CDM,615,RC,70549,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRI BRAIN (W/STEM) W/O,4600013,CDM,611,RC,70551,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI BRAIN (W/STEM) W/,4600031,CDM,611,RC,70552,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI BRAIN (W/STEM) W/WO,4600032,CDM,611,RC,70553,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI BRAIN IAC W/WO,4600073,CDM,611,RC,70553,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI BRAIN SELLA W/WO,4600075,CDM,611,RC,70553,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI CHEST W/O,4600014,CDM,614,RC,71550,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI CHEST W/,4600223,CDM,614,RC,71551,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI CHEST W/WO,4600072,CDM,614,RC,71552,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRA CHEST W/,4600047,CDM,618,RC,71555,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA CHEST W/O,4600048,CDM,618,RC,71555,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA CHEST W/WO,4600049,CDM,618,RC,71555,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,191.44,2863.04,
MRI CERVICAL W/O,4600015,CDM,612,RC,72141,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI CERVICAL W/,4600034,CDM,612,RC,72142,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI THORACIC W/O,4600016,CDM,612,RC,72146,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI THORACIC W/,4600035,CDM,612,RC,72147,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI LUMBAR W/O,4600017,CDM,612,RC,72148,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI LUMBAR W/,4600033,CDM,612,RC,72149,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI CERVICAL W/WO,4600036,CDM,612,RC,72156,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI THORACIC W/WO,4600037,CDM,612,RC,72157,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI LUMBAR W/WO,4600038,CDM,612,RC,72158,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRA SPINE W/,4600059,CDM,618,RC,72159,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRI PELVIS W/O,4600088,CDM,614,RC,72195,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI PELVIS W/,4600018,CDM,614,RC,72196,HCPCS,Outpatient,,,2961,2516.85,,2404.33,81.2,,,percent of total billed charges,81.2% of total billed charges,966.47,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,947.52,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,947.52,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2250.36,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,975.95,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2664.9,90,,,percent of total billed charges,90% of total billed charges,2664.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2623.45,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,947.52,32,,,percent of total billed charges,32% of total billed charges,2368.8,80,,,percent of total billed charges,80% of total billed charges,2368.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2694.51,91,,,percent of total billed charges,91% of total billed charges,966.47,32.64,,,percent of total billed charges,32.64% of total billed charges,947.52,32,,,percent of total billed charges,32% of total billed charges,994.9,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,947.52,32,,,percent of total billed charges,32% of total billed charges,947.52,32,,,percent of total billed charges,32% of total billed charges,2724.12,92,,,percent of total billed charges,92% of total billed charges,237.83,2724.12,
MRI PELVIS W/WO,4600089,CDM,614,RC,72197,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRA PELVIS W/,4600060,CDM,618,RC,72198,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA PELVIS W/O,4600061,CDM,618,RC,72198,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA PELVIS W/WO,4600062,CDM,618,RC,72198,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRI BRACHIAL PLEXUS LT W/O,4600229,CDM,614,RC,73218,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI BRACHIAL PLEXUS RT W/O,4600228,CDM,614,RC,73218,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI HAND LT W/O,4600145,CDM,614,RC,73218,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI HAND RT W/O,4600141,CDM,614,RC,73218,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI BRACHIAL PLEXUS BILAT W/O,4600233,CDM,614,RC,73218,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,157.38,2435.24,
MRI HAND BILAT W/O,4600149,CDM,614,RC,73218,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,157.38,2435.24,
MRI FOREARM LT W/O,4600181,CDM,614,RC,73218,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI FOREARM RT W/O,4600183,CDM,614,RC,73218,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI HUMERUS LT W/O,4600180,CDM,614,RC,73218,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI HUMERUS RT W/O,4600182,CDM,614,RC,73218,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI FOREARM BILAT W/O,4600185,CDM,614,RC,73218,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,157.38,2863.04,
MRI HUMERUS BILAT W/O,4600184,CDM,614,RC,73218,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,157.38,2863.04,
MRI BRACHIAL PLEXUS LT W/,4600226,CDM,614,RC,73219,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI BRACHIAL PLEXUS RT W/,4600227,CDM,614,RC,73219,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI HAND LT W/,4600119,CDM,614,RC,73219,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI HAND RT W/,4600115,CDM,614,RC,73219,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI BRACHIAL PLEXUS BILAT W/,4600232,CDM,614,RC,73219,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,237.83,2435.24,
MRI HAND BILAT W/,4600111,CDM,614,RC,73219,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,237.83,2435.24,
MRI FOREARM LT W/,4600214,CDM,614,RC,73219,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI FOREARM RT W/,4600213,CDM,614,RC,73219,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI HUMERUS LT W/,4600211,CDM,614,RC,73219,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI HUMERUS RT W/,4600210,CDM,614,RC,73219,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI FOREARM BILAT W/,4600215,CDM,614,RC,73219,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI HUMERUS BILAT W/,4600212,CDM,614,RC,73219,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI BRACHIAL PLEXUS LT W/WO,4600230,CDM,614,RC,73220,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI BRACHIAL PLEXUS RT W/WO,4600231,CDM,614,RC,73220,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI FOREARM LT W/WO,4600137,CDM,614,RC,73220,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI FOREARM RT W/WO,4600135,CDM,614,RC,73220,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI HUMERUS LT W/WO,4600136,CDM,614,RC,73220,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI HUMERUS RT W/WO,4600134,CDM,614,RC,73220,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI HAND BILAT W/WO,4600179,CDM,614,RC,73220,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI HAND LT W/WO,4600171,CDM,614,RC,73220,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI HAND RT W/WO,4600175,CDM,614,RC,73220,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI BRACHIAL PLEXUS BILAT W/WO,4600234,CDM,614,RC,73220,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI FOREARM BILAT W/WO,4600187,CDM,614,RC,73220,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI HUMERUS BILAT W/WO,4600186,CDM,614,RC,73220,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI ELBOW LT W/O,4600143,CDM,614,RC,73221,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI ELBOW RT W/O,4600139,CDM,614,RC,73221,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI SHOULDER LT W/O,4600142,CDM,614,RC,73221,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI SHOULDER RT W/O,4600138,CDM,614,RC,73221,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI WRIST LT W/O,4600144,CDM,614,RC,73221,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI WRIST RT W/O,4600140,CDM,614,RC,73221,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,157.38,2043.32,
MRI ELBOW BILAT W/O,4600147,CDM,614,RC,73221,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,157.38,2435.24,
MRI SHOULDER BILAT W/O,4600146,CDM,614,RC,73221,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,157.38,2435.24,
MRI WRIST BILAT W/O,4600148,CDM,614,RC,73221,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,157.38,2435.24,
MRI ARTHRO ELBOW LT,4600002,CDM,614,RC,73222,HCPCS,Outpatient,,,1095,930.75,,889.14,81.2,,,percent of total billed charges,81.2% of total billed charges,357.41,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,350.4,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,350.4,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,832.2,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,360.91,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,985.5,90,,,percent of total billed charges,90% of total billed charges,985.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,970.17,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,350.4,32,,,percent of total billed charges,32% of total billed charges,876,80,,,percent of total billed charges,80% of total billed charges,876,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,996.45,91,,,percent of total billed charges,91% of total billed charges,357.41,32.64,,,percent of total billed charges,32.64% of total billed charges,350.4,32,,,percent of total billed charges,32% of total billed charges,367.92,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,350.4,32,,,percent of total billed charges,32% of total billed charges,350.4,32,,,percent of total billed charges,32% of total billed charges,1007.4,92,,,percent of total billed charges,92% of total billed charges,237.83,1817,
MRI ARTHRO ELBOW RT,4600001,CDM,614,RC,73222,HCPCS,Outpatient,,,1095,930.75,,889.14,81.2,,,percent of total billed charges,81.2% of total billed charges,357.41,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,350.4,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,350.4,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,832.2,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,360.91,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,985.5,90,,,percent of total billed charges,90% of total billed charges,985.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,970.17,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,350.4,32,,,percent of total billed charges,32% of total billed charges,876,80,,,percent of total billed charges,80% of total billed charges,876,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,996.45,91,,,percent of total billed charges,91% of total billed charges,357.41,32.64,,,percent of total billed charges,32.64% of total billed charges,350.4,32,,,percent of total billed charges,32% of total billed charges,367.92,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,350.4,32,,,percent of total billed charges,32% of total billed charges,350.4,32,,,percent of total billed charges,32% of total billed charges,1007.4,92,,,percent of total billed charges,92% of total billed charges,237.83,1817,
MRI ARTHRO ELBOW BILAT,4600003,CDM,614,RC,73222,HCPCS,Outpatient,,,1906,1620.1,,1547.67,81.2,,,percent of total billed charges,81.2% of total billed charges,622.12,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,609.92,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,609.92,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1448.56,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,628.22,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1715.4,90,,,percent of total billed charges,90% of total billed charges,1715.4,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1688.72,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,609.92,32,,,percent of total billed charges,32% of total billed charges,1524.8,80,,,percent of total billed charges,80% of total billed charges,1524.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1734.46,91,,,percent of total billed charges,91% of total billed charges,622.12,32.64,,,percent of total billed charges,32.64% of total billed charges,609.92,32,,,percent of total billed charges,32% of total billed charges,640.42,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,609.92,32,,,percent of total billed charges,32% of total billed charges,609.92,32,,,percent of total billed charges,32% of total billed charges,1753.52,92,,,percent of total billed charges,92% of total billed charges,237.83,1817,
MRI ARTHRO SHOULDER BILAT,4600004,CDM,614,RC,73222,HCPCS,Outpatient,,,1906,1620.1,,1547.67,81.2,,,percent of total billed charges,81.2% of total billed charges,622.12,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,609.92,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,609.92,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1448.56,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,628.22,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1715.4,90,,,percent of total billed charges,90% of total billed charges,1715.4,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1688.72,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,609.92,32,,,percent of total billed charges,32% of total billed charges,1524.8,80,,,percent of total billed charges,80% of total billed charges,1524.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1734.46,91,,,percent of total billed charges,91% of total billed charges,622.12,32.64,,,percent of total billed charges,32.64% of total billed charges,609.92,32,,,percent of total billed charges,32% of total billed charges,640.42,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,609.92,32,,,percent of total billed charges,32% of total billed charges,609.92,32,,,percent of total billed charges,32% of total billed charges,1753.52,92,,,percent of total billed charges,92% of total billed charges,237.83,1817,
MRI ELBOW LT W/,4600117,CDM,614,RC,73222,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI ELBOW RT W/,4600113,CDM,614,RC,73222,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI SHOULDER LT W/,4600116,CDM,614,RC,73222,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI SHOULDER RT W/,4600112,CDM,614,RC,73222,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI WRIST LT WITH,4600118,CDM,614,RC,73222,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI WRIST RT WITH,4600114,CDM,614,RC,73222,HCPCS,Outpatient,,,2221,1887.85,,1803.45,81.2,,,percent of total billed charges,81.2% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,710.72,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1687.96,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,732.04,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1998.9,90,,,percent of total billed charges,90% of total billed charges,1998.9,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1967.81,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,1776.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2021.11,91,,,percent of total billed charges,91% of total billed charges,724.93,32.64,,,percent of total billed charges,32.64% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,746.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,710.72,32,,,percent of total billed charges,32% of total billed charges,710.72,32,,,percent of total billed charges,32% of total billed charges,2043.32,92,,,percent of total billed charges,92% of total billed charges,237.83,2043.32,
MRI ELBOW BILAT W/,4600109,CDM,614,RC,73222,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,237.83,2435.24,
MRI SHOULDER BILAT W/,4600108,CDM,614,RC,73222,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,237.83,2435.24,
MRI WRIST BILAT W/,4600110,CDM,614,RC,73222,HCPCS,Outpatient,,,2647,2249.95,,2149.36,81.2,,,percent of total billed charges,81.2% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,847.04,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2011.72,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,872.45,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2345.24,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,2117.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2408.77,91,,,percent of total billed charges,91% of total billed charges,863.98,32.64,,,percent of total billed charges,32.64% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,889.39,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,847.04,32,,,percent of total billed charges,32% of total billed charges,847.04,32,,,percent of total billed charges,32% of total billed charges,2435.24,92,,,percent of total billed charges,92% of total billed charges,237.83,2435.24,
MRI ARTHRO WRIST LT,4600104,CDM,614,RC,73222,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ARTHRO WRIST RT,4600099,CDM,614,RC,73222,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ARTHRO SHOULDER LT,4600005,CDM,614,RC,73222,HCPCS,Outpatient,,,3214,2731.9,,2609.77,81.2,,,percent of total billed charges,81.2% of total billed charges,1049.05,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1028.48,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2442.64,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1059.33,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2892.6,90,,,percent of total billed charges,90% of total billed charges,2892.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2847.6,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,2571.2,80,,,percent of total billed charges,80% of total billed charges,2571.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2924.74,91,,,percent of total billed charges,91% of total billed charges,1049.05,32.64,,,percent of total billed charges,32.64% of total billed charges,1028.48,32,,,percent of total billed charges,32% of total billed charges,1079.9,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,1028.48,32,,,percent of total billed charges,32% of total billed charges,2956.88,92,,,percent of total billed charges,92% of total billed charges,237.83,2956.88,
MRI ARTHRO SHOULDER RT,4600006,CDM,614,RC,73222,HCPCS,Outpatient,,,3214,2731.9,,2609.77,81.2,,,percent of total billed charges,81.2% of total billed charges,1049.05,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1028.48,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2442.64,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1059.33,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2892.6,90,,,percent of total billed charges,90% of total billed charges,2892.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2847.6,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,2571.2,80,,,percent of total billed charges,80% of total billed charges,2571.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2924.74,91,,,percent of total billed charges,91% of total billed charges,1049.05,32.64,,,percent of total billed charges,32.64% of total billed charges,1028.48,32,,,percent of total billed charges,32% of total billed charges,1079.9,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,1028.48,32,,,percent of total billed charges,32% of total billed charges,2956.88,92,,,percent of total billed charges,92% of total billed charges,237.83,2956.88,
MRI ARTHRO WRIST BILAT,4600105,CDM,614,RC,73222,HCPCS,Outpatient,,,4702,3996.7,,3818.02,81.2,,,percent of total billed charges,81.2% of total billed charges,1534.73,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1504.64,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1504.64,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,3573.52,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1549.78,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,4231.8,90,,,percent of total billed charges,90% of total billed charges,4231.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,4165.97,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1504.64,32,,,percent of total billed charges,32% of total billed charges,3761.6,80,,,percent of total billed charges,80% of total billed charges,3761.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,4278.82,91,,,percent of total billed charges,91% of total billed charges,1534.73,32.64,,,percent of total billed charges,32.64% of total billed charges,1504.64,32,,,percent of total billed charges,32% of total billed charges,1579.87,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1504.64,32,,,percent of total billed charges,32% of total billed charges,1504.64,32,,,percent of total billed charges,32% of total billed charges,4325.84,92,,,percent of total billed charges,92% of total billed charges,237.83,4325.84,
MRI ELBOW LT W/WO,4600169,CDM,614,RC,73223,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ELBOW RT W/WO,4600173,CDM,614,RC,73223,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI SHOULDER LT W/WO,4600168,CDM,614,RC,73223,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI SHOULDER RT W/WO,4600172,CDM,614,RC,73223,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI WRIST LT W/WO,4600170,CDM,614,RC,73223,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI WRIST RT W/WO,4600174,CDM,614,RC,73223,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ELBOW BILAT W/WO,4600177,CDM,614,RC,73223,HCPCS,Outpatient,,,4116,3498.6,,3342.19,81.2,,,percent of total billed charges,81.2% of total billed charges,1343.46,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1317.12,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1317.12,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,3128.16,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1356.63,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,3704.4,90,,,percent of total billed charges,90% of total billed charges,3704.4,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,3646.78,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1317.12,32,,,percent of total billed charges,32% of total billed charges,3292.8,80,,,percent of total billed charges,80% of total billed charges,3292.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,3745.56,91,,,percent of total billed charges,91% of total billed charges,1343.46,32.64,,,percent of total billed charges,32.64% of total billed charges,1317.12,32,,,percent of total billed charges,32% of total billed charges,1382.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1317.12,32,,,percent of total billed charges,32% of total billed charges,1317.12,32,,,percent of total billed charges,32% of total billed charges,3786.72,92,,,percent of total billed charges,92% of total billed charges,237.83,3786.72,
MRI SHOULDER BILAT W/WO,4600176,CDM,614,RC,73223,HCPCS,Outpatient,,,4116,3498.6,,3342.19,81.2,,,percent of total billed charges,81.2% of total billed charges,1343.46,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1317.12,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1317.12,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,3128.16,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1356.63,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,3704.4,90,,,percent of total billed charges,90% of total billed charges,3704.4,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,3646.78,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1317.12,32,,,percent of total billed charges,32% of total billed charges,3292.8,80,,,percent of total billed charges,80% of total billed charges,3292.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,3745.56,91,,,percent of total billed charges,91% of total billed charges,1343.46,32.64,,,percent of total billed charges,32.64% of total billed charges,1317.12,32,,,percent of total billed charges,32% of total billed charges,1382.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1317.12,32,,,percent of total billed charges,32% of total billed charges,1317.12,32,,,percent of total billed charges,32% of total billed charges,3786.72,92,,,percent of total billed charges,92% of total billed charges,237.83,3786.72,
MRI WRIST BILAT W/WO,4600224,CDM,614,RC,73223,HCPCS,Outpatient,,,4116,3498.6,,3342.19,81.2,,,percent of total billed charges,81.2% of total billed charges,1343.46,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1317.12,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1317.12,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,3128.16,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1356.63,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,3704.4,90,,,percent of total billed charges,90% of total billed charges,3704.4,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,3646.78,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1317.12,32,,,percent of total billed charges,32% of total billed charges,3292.8,80,,,percent of total billed charges,80% of total billed charges,3292.8,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,3745.56,91,,,percent of total billed charges,91% of total billed charges,1343.46,32.64,,,percent of total billed charges,32.64% of total billed charges,1317.12,32,,,percent of total billed charges,32% of total billed charges,1382.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1317.12,32,,,percent of total billed charges,32% of total billed charges,1317.12,32,,,percent of total billed charges,32% of total billed charges,3786.72,92,,,percent of total billed charges,92% of total billed charges,237.83,3786.72,
MRA UP EX LT W/,4600063,CDM,618,RC,73225,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA UP EX RT W/,4600064,CDM,618,RC,73225,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA UP EX BI W/,4600065,CDM,618,RC,73225,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,191.44,2863.04,
MRI FEMUR LT W/O,4600164,CDM,614,RC,73718,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI FEMUR RT W/O,4600162,CDM,614,RC,73718,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI FOOT LT W/O,4600191,CDM,614,RC,73718,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI FOOT RT W/O,4600123,CDM,614,RC,73718,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI TIB/FIB RT W/O,4600163,CDM,614,RC,73718,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI FEMUR BILAT W/O,4600166,CDM,614,RC,73718,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,157.38,2863.04,
MRI FOOT BILAT W/O,4600127,CDM,614,RC,73718,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,157.38,2863.04,
MRI TIB/FIB BILAT W/O,4600165,CDM,614,RC,73718,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,157.38,2863.04,
MRI TIB/FIB LT W/O,4600167,CDM,614,RC,73718,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,157.38,2863.04,
MRI FEMUR LT W/,4600205,CDM,614,RC,73719,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI FEMUR RT W/,4600204,CDM,614,RC,73719,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI FOOT LT W/,4600199,CDM,614,RC,73719,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI FOOT RT W/,4600195,CDM,614,RC,73719,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI TIB/FIB LT W/,4600208,CDM,614,RC,73719,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI TIB/FIB RT W/,4600207,CDM,614,RC,73719,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI FEMUR BILAT W/,4600206,CDM,614,RC,73719,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI FOOT BILAT W/,4600203,CDM,614,RC,73719,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI TIB/FIB BILAT W/,4600209,CDM,614,RC,73719,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI FEMUR BILAT W/WO,4600132,CDM,614,RC,73720,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI FEMUR LT W/WO,4600128,CDM,614,RC,73720,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI FEMUR RT W/WO,4600130,CDM,614,RC,73720,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI TIB/FIB BILAT W/WO,4600133,CDM,614,RC,73720,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI TIB/FIB LT W/WO,4600129,CDM,614,RC,73720,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI TIB/FIB RT W/WO,4600131,CDM,614,RC,73720,HCPCS,Outpatient,,,2665,2265.25,,2163.98,81.2,,,percent of total billed charges,81.2% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,852.8,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2025.4,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.38,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2398.5,90,,,percent of total billed charges,90% of total billed charges,2398.5,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2361.19,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,2132,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2425.15,91,,,percent of total billed charges,91% of total billed charges,869.86,32.64,,,percent of total billed charges,32.64% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,895.44,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,852.8,32,,,percent of total billed charges,32% of total billed charges,852.8,32,,,percent of total billed charges,32% of total billed charges,2451.8,92,,,percent of total billed charges,92% of total billed charges,237.83,2451.8,
MRI FOOT LT W/WO,4600157,CDM,614,RC,73720,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI FOOT RT W/WO,4600161,CDM,614,RC,73720,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI FOOT BILAT W/WO,4600153,CDM,614,RC,73720,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI ANKLE LT W/O,4600190,CDM,614,RC,73721,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI ANKLE RT W/O,4600122,CDM,614,RC,73721,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI HIP LT W/O,4600188,CDM,614,RC,73721,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI HIP RT W/O,4600120,CDM,614,RC,73721,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI KNEE LT W/O,4600189,CDM,614,RC,73721,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI KNEE RT W/O,4600121,CDM,614,RC,73721,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI ANKLE BILAT W/O,4600126,CDM,614,RC,73721,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,157.38,2863.04,
MRI HIP BILAT W/O,4600124,CDM,614,RC,73721,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,157.38,2863.04,
MRI KNEE BILAT W/O,4600125,CDM,614,RC,73721,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,157.38,2863.04,
MRI ARTHRO KNEE LT,4600100,CDM,614,RC,73722,HCPCS,Outpatient,,,1147,974.95,,931.36,81.2,,,percent of total billed charges,81.2% of total billed charges,374.38,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,367.04,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,367.04,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,871.72,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,378.05,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,1032.3,90,,,percent of total billed charges,90% of total billed charges,1032.3,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1016.24,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,367.04,32,,,percent of total billed charges,32% of total billed charges,917.6,80,,,percent of total billed charges,80% of total billed charges,917.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,1043.77,91,,,percent of total billed charges,91% of total billed charges,374.38,32.64,,,percent of total billed charges,32.64% of total billed charges,367.04,32,,,percent of total billed charges,32% of total billed charges,385.39,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,367.04,32,,,percent of total billed charges,32% of total billed charges,367.04,32,,,percent of total billed charges,32% of total billed charges,1055.24,92,,,percent of total billed charges,92% of total billed charges,237.83,1817,
MRI ANKLE LT W/,4600198,CDM,614,RC,73722,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ANKLE RT W/,4600194,CDM,614,RC,73722,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ARTHRO KNEE RT,4600102,CDM,614,RC,73722,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI HIP LT W/,4600196,CDM,614,RC,73722,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI HIP RT W/,4600192,CDM,614,RC,73722,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI KNEE LT W/,4600197,CDM,614,RC,73722,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI KNEE RT W/,4600193,CDM,614,RC,73722,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ANKLE BILAT W/,4600202,CDM,614,RC,73722,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI HIP BILAT W/,4600200,CDM,614,RC,73722,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI KNEE BILAT W/,4600201,CDM,614,RC,73722,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI ARTHRO HIP LT,4600095,CDM,614,RC,73722,HCPCS,Outpatient,,,3214,2731.9,,2609.77,81.2,,,percent of total billed charges,81.2% of total billed charges,1049.05,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1028.48,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2442.64,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1059.33,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2892.6,90,,,percent of total billed charges,90% of total billed charges,2892.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2847.6,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,2571.2,80,,,percent of total billed charges,80% of total billed charges,2571.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2924.74,91,,,percent of total billed charges,91% of total billed charges,1049.05,32.64,,,percent of total billed charges,32.64% of total billed charges,1028.48,32,,,percent of total billed charges,32% of total billed charges,1079.9,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,1028.48,32,,,percent of total billed charges,32% of total billed charges,2956.88,92,,,percent of total billed charges,92% of total billed charges,237.83,2956.88,
MRI ARTHRO HIP RT,4600010,CDM,614,RC,73722,HCPCS,Outpatient,,,3214,2731.9,,2609.77,81.2,,,percent of total billed charges,81.2% of total billed charges,1049.05,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1028.48,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2442.64,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1059.33,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2892.6,90,,,percent of total billed charges,90% of total billed charges,2892.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2847.6,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,2571.2,80,,,percent of total billed charges,80% of total billed charges,2571.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2924.74,91,,,percent of total billed charges,91% of total billed charges,1049.05,32.64,,,percent of total billed charges,32.64% of total billed charges,1028.48,32,,,percent of total billed charges,32% of total billed charges,1079.9,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1028.48,32,,,percent of total billed charges,32% of total billed charges,1028.48,32,,,percent of total billed charges,32% of total billed charges,2956.88,92,,,percent of total billed charges,92% of total billed charges,237.83,2956.88,
MRI ARTHRO HIP BILAT,4600101,CDM,614,RC,73722,HCPCS,Outpatient,,,4702,3996.7,,3818.02,81.2,,,percent of total billed charges,81.2% of total billed charges,1534.73,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1504.64,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1504.64,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,3573.52,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1549.78,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,4231.8,90,,,percent of total billed charges,90% of total billed charges,4231.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,4165.97,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1504.64,32,,,percent of total billed charges,32% of total billed charges,3761.6,80,,,percent of total billed charges,80% of total billed charges,3761.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,4278.82,91,,,percent of total billed charges,91% of total billed charges,1534.73,32.64,,,percent of total billed charges,32.64% of total billed charges,1504.64,32,,,percent of total billed charges,32% of total billed charges,1579.87,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1504.64,32,,,percent of total billed charges,32% of total billed charges,1504.64,32,,,percent of total billed charges,32% of total billed charges,4325.84,92,,,percent of total billed charges,92% of total billed charges,237.83,4325.84,
MRI ARTHRO KNEE BILAT,4600103,CDM,614,RC,73722,HCPCS,Outpatient,,,4702,3996.7,,3818.02,81.2,,,percent of total billed charges,81.2% of total billed charges,1534.73,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1504.64,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1504.64,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,3573.52,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1549.78,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,4231.8,90,,,percent of total billed charges,90% of total billed charges,4231.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,4165.97,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1504.64,32,,,percent of total billed charges,32% of total billed charges,3761.6,80,,,percent of total billed charges,80% of total billed charges,3761.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,4278.82,91,,,percent of total billed charges,91% of total billed charges,1534.73,32.64,,,percent of total billed charges,32.64% of total billed charges,1504.64,32,,,percent of total billed charges,32% of total billed charges,1579.87,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,1504.64,32,,,percent of total billed charges,32% of total billed charges,1504.64,32,,,percent of total billed charges,32% of total billed charges,4325.84,92,,,percent of total billed charges,92% of total billed charges,237.83,4325.84,
MRI ANKLE LT W/WO,4600156,CDM,614,RC,73723,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ANKLE RT W/WO,4600160,CDM,614,RC,73723,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI HIP LT WWO,4600154,CDM,614,RC,73723,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI HIP RT W/WO,4600158,CDM,614,RC,73723,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI KNEE LT W/WO,4600155,CDM,614,RC,73723,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI KNEE RT W/WO,4600159,CDM,614,RC,73723,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ANKLE BILAT W/WO,4600152,CDM,614,RC,73723,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI HIP BILAT W/WO,4600150,CDM,614,RC,73723,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRI KNEE BILAT W/WO,4600151,CDM,614,RC,73723,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,237.83,2863.04,
MRA LOW EX BILAT W/O,4600055,CDM,616,RC,73725,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA LOW EX LT W/,4600050,CDM,616,RC,73725,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA LOW EX LT W/O,4600053,CDM,616,RC,73725,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA LOW EX LT W/WO,4600056,CDM,616,RC,73725,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA LOW EX RT W/,4600051,CDM,616,RC,73725,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA LOW EX RT W/O,4600054,CDM,616,RC,73725,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA LOW EX RT W/WO,4600057,CDM,616,RC,73725,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA LOW EX BILAT W/WO,4600058,CDM,616,RC,73725,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,191.44,2863.04,
MRA LOW EX BILAT W/,4600052,CDM,616,RC,73725,HCPCS,Outpatient,,,3928,3338.8,,3189.54,81.2,,,percent of total billed charges,81.2% of total billed charges,1282.1,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,1256.96,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,1256.96,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2985.28,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,1294.67,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,3535.2,90,,,percent of total billed charges,90% of total billed charges,3535.2,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,3480.21,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,1256.96,32,,,percent of total billed charges,32% of total billed charges,3142.4,80,,,percent of total billed charges,80% of total billed charges,3142.4,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,3574.48,91,,,percent of total billed charges,91% of total billed charges,1282.1,32.64,,,percent of total billed charges,32.64% of total billed charges,1256.96,32,,,percent of total billed charges,32% of total billed charges,1319.81,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,1256.96,32,,,percent of total billed charges,32% of total billed charges,1256.96,32,,,percent of total billed charges,32% of total billed charges,3613.76,92,,,percent of total billed charges,92% of total billed charges,191.44,3613.76,
MRCP,4600217,CDM,614,RC,74181,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI ABD W/O,4600019,CDM,614,RC,74181,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,162.1,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,165.25,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,157.38,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,162.1,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,157.38,2524.48,
MRI ABD W/,4600070,CDM,614,RC,74182,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRI ABD W/WO,4600069,CDM,614,RC,74183,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,244.97,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,249.73,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,237.83,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,244.97,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,237.83,2524.48,
MRA ABD W/,4600044,CDM,618,RC,74185,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA ABD W/O,4600046,CDM,618,RC,74185,HCPCS,Outpatient,,,2744,2332.4,,2228.13,81.2,,,percent of total billed charges,81.2% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,878.08,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2085.44,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,904.42,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2469.6,90,,,percent of total billed charges,90% of total billed charges,2469.6,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2431.18,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,2195.2,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2497.04,91,,,percent of total billed charges,91% of total billed charges,895.64,32.64,,,percent of total billed charges,32.64% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,921.98,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,878.08,32,,,percent of total billed charges,32% of total billed charges,878.08,32,,,percent of total billed charges,32% of total billed charges,2524.48,92,,,percent of total billed charges,92% of total billed charges,191.44,2524.48,
MRA ABD W/WO,4600045,CDM,618,RC,74185,HCPCS,Outpatient,,,3112,2645.2,,2526.94,81.2,,,percent of total billed charges,81.2% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,1817,100,,,Case rate,Pays based on per visit,1817,100,,,Case rate,Pays based on per visit,995.84,32,,,percent of total billed charges,32% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,1726,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1635,100,,,Case rate,pays based on per visit,1726,100,,,Case rate,pays based on per visit,2365.12,100,,,Case rate,pays based on per visit,197.19,103,,,Fee Schedule,pays based on EAPG rates,1025.72,32.96,,,percent of total billed charges,32.96% of total billed charges,201.02,105,,,Fee Schedule,pays based on EAPG rates,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2757.23,88.6,,,percent of total billed charges,88.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,2489.6,80,,,percent of total billed charges,80% of total billed charges,191.44,100,,,Fee Schedule,pays based on EAPG rates,2831.92,91,,,percent of total billed charges,91% of total billed charges,1015.76,32.64,,,percent of total billed charges,32.64% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,1045.63,33.6,,,percent of total billed charges,33.6% of total billed charges,197.19,103,,,Fee Schedule,pays based on EAPG rates,995.84,32,,,percent of total billed charges,32% of total billed charges,995.84,32,,,percent of total billed charges,32% of total billed charges,2863.04,92,,,percent of total billed charges,92% of total billed charges,191.44,2863.04,
MRI CONTRAST PROHANCE 10ML,4600219,CDM,636,RC,A9579,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,15.39,284.28,
MRI CONTRAST PROHANCE 15ML,4600220,CDM,636,RC,A9579,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,15.39,284.28,
MRI CONTRAST PROHANCE 20ML,4600221,CDM,636,RC,A9579,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,15.39,284.28,
MRI CONTRAST EOVIST,4600225,CDM,255,RC,A9581,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,15.39,284.28,
"SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC",6500009,CDM,510,RC,62270,HCPCS,Outpatient,,,2020,1717,,1640.24,81.2,,,percent of total billed charges,81.2% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1535.2,76,,,percent of total billed charges,76% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,665.79,32.96,,,percent of total billed charges,32.96% of total billed charges,365.8,105,,,Fee Schedule,pays based on EAPG rates,1818,90,,,percent of total billed charges,90% of total billed charges,1818,90,,,percent of total billed charges,90% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1789.72,88.6,,,percent of total billed charges,88.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1838.2,91,,,percent of total billed charges,91% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,678.72,33.6,,,percent of total billed charges,33.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,1858.4,92,,,percent of total billed charges,92% of total billed charges,348.38,1858.4,
"SPINAL PUNCTURE, THERAPEUTIC",6500010,CDM,510,RC,62272,HCPCS,Outpatient,,,2020,1717,,1640.24,81.2,,,percent of total billed charges,81.2% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1535.2,76,,,percent of total billed charges,76% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,665.79,32.96,,,percent of total billed charges,32.96% of total billed charges,365.8,105,,,Fee Schedule,pays based on EAPG rates,1818,90,,,percent of total billed charges,90% of total billed charges,1818,90,,,percent of total billed charges,90% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1789.72,88.6,,,percent of total billed charges,88.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1838.2,91,,,percent of total billed charges,91% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,678.72,33.6,,,percent of total billed charges,33.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,1858.4,92,,,percent of total billed charges,92% of total billed charges,348.38,1858.4,
INJECTION- TRIGEMINAL NERVE,6500011,CDM,510,RC,64400,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
NERVE BLOCK GREATER OCCIPITAL RT,6500012,CDM,510,RC,64405,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
NERVE BLOCK GREATER OCCIPITAL BIL,6500048,CDM,510,RC,64405,HCPCS,Outpatient,,,1248,1060.8,,1013.38,81.2,,,percent of total billed charges,81.2% of total billed charges,407.35,32.64,,,percent of total billed charges,32.64% of total billed charges,923.52,74,,,percent of total billed charges,74% of total billed charges,923.52,74,,,percent of total billed charges,74% of total billed charges,399.36,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,399.36,32,,,percent of total billed charges,32% of total billed charges,886.08,71,,,percent of total billed charges,71% of total billed charges,886.08,71,,,percent of total billed charges,71% of total billed charges,836.16,67,,,percent of total billed charges,67% of total billed charges,836.16,67,,,percent of total billed charges,67% of total billed charges,886.08,71,,,percent of total billed charges,71% of total billed charges,948.48,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,411.34,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1123.2,90,,,percent of total billed charges,90% of total billed charges,1123.2,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1105.73,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,399.36,32,,,percent of total billed charges,32% of total billed charges,998.4,80,,,percent of total billed charges,80% of total billed charges,998.4,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1135.68,91,,,percent of total billed charges,91% of total billed charges,407.35,32.64,,,percent of total billed charges,32.64% of total billed charges,399.36,32,,,percent of total billed charges,32% of total billed charges,419.33,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,399.36,32,,,percent of total billed charges,32% of total billed charges,399.36,32,,,percent of total billed charges,32% of total billed charges,1148.16,92,,,percent of total billed charges,92% of total billed charges,178.23,1148.16,
NB PERIPHEARAL NERVE OR BRANCH,6500014,CDM,510,RC,64450,HCPCS,Outpatient,,,2020,1717,,1640.24,81.2,,,percent of total billed charges,81.2% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1535.2,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,665.79,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1818,90,,,percent of total billed charges,90% of total billed charges,1818,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1789.72,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1838.2,91,,,percent of total billed charges,91% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,678.72,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,1858.4,92,,,percent of total billed charges,92% of total billed charges,178.23,1858.4,
NB PERIPHEARAL NERVE OR BRANCH B/L,6500015,CDM,510,RC,64450,HCPCS,Outpatient,,,3030,2575.5,,2460.36,81.2,,,percent of total billed charges,81.2% of total billed charges,988.99,32.64,,,percent of total billed charges,32.64% of total billed charges,2242.2,74,,,percent of total billed charges,74% of total billed charges,2242.2,74,,,percent of total billed charges,74% of total billed charges,969.6,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,969.6,32,,,percent of total billed charges,32% of total billed charges,2151.3,71,,,percent of total billed charges,71% of total billed charges,2151.3,71,,,percent of total billed charges,71% of total billed charges,2030.1,67,,,percent of total billed charges,67% of total billed charges,2030.1,67,,,percent of total billed charges,67% of total billed charges,2151.3,71,,,percent of total billed charges,71% of total billed charges,2302.8,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,998.69,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,2727,90,,,percent of total billed charges,90% of total billed charges,2727,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,2684.58,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,969.6,32,,,percent of total billed charges,32% of total billed charges,2424,80,,,percent of total billed charges,80% of total billed charges,2424,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,2757.3,91,,,percent of total billed charges,91% of total billed charges,988.99,32.64,,,percent of total billed charges,32.64% of total billed charges,969.6,32,,,percent of total billed charges,32% of total billed charges,1018.08,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,969.6,32,,,percent of total billed charges,32% of total billed charges,969.6,32,,,percent of total billed charges,32% of total billed charges,2787.6,92,,,percent of total billed charges,92% of total billed charges,178.23,2787.6,
NB SPENOPALATINE GANGLION LT,6500016,CDM,510,RC,64505,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
NB SPENOPALATINE GANGLION RT,6500017,CDM,510,RC,64505,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
NB SPENOPALATINE GANGLION B/L,6500018,CDM,510,RC,64505,HCPCS,Outpatient,,,1246,1059.1,,1011.75,81.2,,,percent of total billed charges,81.2% of total billed charges,406.69,32.64,,,percent of total billed charges,32.64% of total billed charges,922.04,74,,,percent of total billed charges,74% of total billed charges,922.04,74,,,percent of total billed charges,74% of total billed charges,398.72,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,398.72,32,,,percent of total billed charges,32% of total billed charges,884.66,71,,,percent of total billed charges,71% of total billed charges,884.66,71,,,percent of total billed charges,71% of total billed charges,834.82,67,,,percent of total billed charges,67% of total billed charges,834.82,67,,,percent of total billed charges,67% of total billed charges,884.66,71,,,percent of total billed charges,71% of total billed charges,946.96,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,410.68,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1121.4,90,,,percent of total billed charges,90% of total billed charges,1121.4,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1103.96,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,398.72,32,,,percent of total billed charges,32% of total billed charges,996.8,80,,,percent of total billed charges,80% of total billed charges,996.8,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1133.86,91,,,percent of total billed charges,91% of total billed charges,406.69,32.64,,,percent of total billed charges,32.64% of total billed charges,398.72,32,,,percent of total billed charges,32% of total billed charges,418.66,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,398.72,32,,,percent of total billed charges,32% of total billed charges,398.72,32,,,percent of total billed charges,32% of total billed charges,1146.32,92,,,percent of total billed charges,92% of total billed charges,178.23,1146.32,
CHEMODENERVATION PAROTID/SALIVARY,6500021,CDM,510,RC,64611,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
CHEMODENERVATION FACIAL NERVE LT,6500022,CDM,510,RC,64612,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
CHEMODENERVATION FACIAL NERVE RT,6500023,CDM,510,RC,64612,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
CHEMODENERVATION FACIAL NERVE B/L,6500024,CDM,510,RC,64612,HCPCS,Outpatient,,,1246,1059.1,,1011.75,81.2,,,percent of total billed charges,81.2% of total billed charges,406.69,32.64,,,percent of total billed charges,32.64% of total billed charges,922.04,74,,,percent of total billed charges,74% of total billed charges,922.04,74,,,percent of total billed charges,74% of total billed charges,398.72,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,398.72,32,,,percent of total billed charges,32% of total billed charges,884.66,71,,,percent of total billed charges,71% of total billed charges,884.66,71,,,percent of total billed charges,71% of total billed charges,834.82,67,,,percent of total billed charges,67% of total billed charges,834.82,67,,,percent of total billed charges,67% of total billed charges,884.66,71,,,percent of total billed charges,71% of total billed charges,946.96,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,410.68,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1121.4,90,,,percent of total billed charges,90% of total billed charges,1121.4,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1103.96,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,398.72,32,,,percent of total billed charges,32% of total billed charges,996.8,80,,,percent of total billed charges,80% of total billed charges,996.8,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1133.86,91,,,percent of total billed charges,91% of total billed charges,406.69,32.64,,,percent of total billed charges,32.64% of total billed charges,398.72,32,,,percent of total billed charges,32% of total billed charges,418.66,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,398.72,32,,,percent of total billed charges,32% of total billed charges,398.72,32,,,percent of total billed charges,32% of total billed charges,1146.32,92,,,percent of total billed charges,92% of total billed charges,178.23,1146.32,
CHEMODENERVATION MIGRAINE,6500025,CDM,510,RC,64615,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
CHEMODENERVATION NECK MUSCLES LT,6500026,CDM,510,RC,64616,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
CHEMODENERVATION NECK MUSCLES RT,6500027,CDM,510,RC,64616,HCPCS,Outpatient,,,832,707.2,,675.58,81.2,,,percent of total billed charges,81.2% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,615.68,74,,,percent of total billed charges,74% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,557.44,67,,,percent of total billed charges,67% of total billed charges,590.72,71,,,percent of total billed charges,71% of total billed charges,632.32,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,274.23,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,748.8,90,,,percent of total billed charges,90% of total billed charges,748.8,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,737.15,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,665.6,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,757.12,91,,,percent of total billed charges,91% of total billed charges,271.56,32.64,,,percent of total billed charges,32.64% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,279.55,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,266.24,32,,,percent of total billed charges,32% of total billed charges,266.24,32,,,percent of total billed charges,32% of total billed charges,765.44,92,,,percent of total billed charges,92% of total billed charges,178.23,765.44,
CHEMODENERVATION NECK MUSCLES B/L,6500028,CDM,510,RC,64616,HCPCS,Outpatient,,,1246,1059.1,,1011.75,81.2,,,percent of total billed charges,81.2% of total billed charges,406.69,32.64,,,percent of total billed charges,32.64% of total billed charges,922.04,74,,,percent of total billed charges,74% of total billed charges,922.04,74,,,percent of total billed charges,74% of total billed charges,398.72,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,398.72,32,,,percent of total billed charges,32% of total billed charges,884.66,71,,,percent of total billed charges,71% of total billed charges,884.66,71,,,percent of total billed charges,71% of total billed charges,834.82,67,,,percent of total billed charges,67% of total billed charges,834.82,67,,,percent of total billed charges,67% of total billed charges,884.66,71,,,percent of total billed charges,71% of total billed charges,946.96,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,410.68,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1121.4,90,,,percent of total billed charges,90% of total billed charges,1121.4,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1103.96,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,398.72,32,,,percent of total billed charges,32% of total billed charges,996.8,80,,,percent of total billed charges,80% of total billed charges,996.8,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1133.86,91,,,percent of total billed charges,91% of total billed charges,406.69,32.64,,,percent of total billed charges,32.64% of total billed charges,398.72,32,,,percent of total billed charges,32% of total billed charges,418.66,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,398.72,32,,,percent of total billed charges,32% of total billed charges,398.72,32,,,percent of total billed charges,32% of total billed charges,1146.32,92,,,percent of total billed charges,92% of total billed charges,178.23,1146.32,
CHEMODENERVATION 1 EXT (1-4 MUSCLES),6500029,CDM,510,RC,64642,HCPCS,Outpatient,,,2020,1717,,1640.24,81.2,,,percent of total billed charges,81.2% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1535.2,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,665.79,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1818,90,,,percent of total billed charges,90% of total billed charges,1818,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1789.72,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1838.2,91,,,percent of total billed charges,91% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,678.72,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,1858.4,92,,,percent of total billed charges,92% of total billed charges,178.23,1858.4,
CHEMODENERVATION ADDTL EXT (1-4 MUSCLES),6500030,CDM,510,RC,64643,HCPCS,Outpatient,,,2020,1717,,1640.24,81.2,,,percent of total billed charges,81.2% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,446.55,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1535.2,76,,,percent of total billed charges,76% of total billed charges,446.55,103,,,Fee Schedule,pays based on EAPG rates,665.79,32.96,,,percent of total billed charges,32.96% of total billed charges,455.22,105,,,Fee Schedule,pays based on EAPG rates,1818,90,,,percent of total billed charges,90% of total billed charges,1818,90,,,percent of total billed charges,90% of total billed charges,433.54,100,,,Fee Schedule,pays based on EAPG rates,1789.72,88.6,,,percent of total billed charges,88.6% of total billed charges,446.55,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,433.54,100,,,Fee Schedule,pays based on EAPG rates,1838.2,91,,,percent of total billed charges,91% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,678.72,33.6,,,percent of total billed charges,33.6% of total billed charges,446.55,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,1858.4,92,,,percent of total billed charges,92% of total billed charges,433.54,1858.4,
CHEMODENERVATION 1 EXT (5+MUSCLES),6500031,CDM,510,RC,64644,HCPCS,Outpatient,,,2020,1717,,1640.24,81.2,,,percent of total billed charges,81.2% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1535.2,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,665.79,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1818,90,,,percent of total billed charges,90% of total billed charges,1818,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1789.72,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1838.2,91,,,percent of total billed charges,91% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,678.72,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,1858.4,92,,,percent of total billed charges,92% of total billed charges,178.23,1858.4,
CHEMODENERVATION ADDTL EXT (5+ MUSCLES),6500032,CDM,510,RC,64645,HCPCS,Outpatient,,,2020,1717,,1640.24,81.2,,,percent of total billed charges,81.2% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,446.55,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1535.2,76,,,percent of total billed charges,76% of total billed charges,446.55,103,,,Fee Schedule,pays based on EAPG rates,665.79,32.96,,,percent of total billed charges,32.96% of total billed charges,455.22,105,,,Fee Schedule,pays based on EAPG rates,1818,90,,,percent of total billed charges,90% of total billed charges,1818,90,,,percent of total billed charges,90% of total billed charges,433.54,100,,,Fee Schedule,pays based on EAPG rates,1789.72,88.6,,,percent of total billed charges,88.6% of total billed charges,446.55,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,433.54,100,,,Fee Schedule,pays based on EAPG rates,1838.2,91,,,percent of total billed charges,91% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,678.72,33.6,,,percent of total billed charges,33.6% of total billed charges,446.55,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,1858.4,92,,,percent of total billed charges,92% of total billed charges,433.54,1858.4,
CHEMODENERVATION TRUNK (1-5 MUSCLES),6500033,CDM,510,RC,64646,HCPCS,Outpatient,,,2020,1717,,1640.24,81.2,,,percent of total billed charges,81.2% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1535.2,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,665.79,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1818,90,,,percent of total billed charges,90% of total billed charges,1818,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1789.72,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1838.2,91,,,percent of total billed charges,91% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,678.72,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,1858.4,92,,,percent of total billed charges,92% of total billed charges,178.23,1858.4,
CHEMODENERVATION TRUNK (6+ MUSCLES),6500034,CDM,510,RC,64647,HCPCS,Outpatient,,,2020,1717,,1640.24,81.2,,,percent of total billed charges,81.2% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,1494.8,74,,,percent of total billed charges,74% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1353.4,67,,,percent of total billed charges,67% of total billed charges,1434.2,71,,,percent of total billed charges,71% of total billed charges,1535.2,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,665.79,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1818,90,,,percent of total billed charges,90% of total billed charges,1818,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1789.72,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,1616,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1838.2,91,,,percent of total billed charges,91% of total billed charges,659.33,32.64,,,percent of total billed charges,32.64% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,678.72,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,646.4,32,,,percent of total billed charges,32% of total billed charges,646.4,32,,,percent of total billed charges,32% of total billed charges,1858.4,92,,,percent of total billed charges,92% of total billed charges,178.23,1858.4,
EEG - AWAKE AND DROWSY,6500035,CDM,740,RC,95816,HCPCS,Outpatient,,,842,715.7,,683.7,81.2,,,percent of total billed charges,81.2% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,133.87,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,639.92,76,,,percent of total billed charges,76% of total billed charges,133.87,103,,,Fee Schedule,pays based on EAPG rates,277.52,32.96,,,percent of total billed charges,32.96% of total billed charges,136.47,105,,,Fee Schedule,pays based on EAPG rates,757.8,90,,,percent of total billed charges,90% of total billed charges,757.8,90,,,percent of total billed charges,90% of total billed charges,129.97,100,,,Fee Schedule,pays based on EAPG rates,746.01,88.6,,,percent of total billed charges,88.6% of total billed charges,133.87,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,129.97,100,,,Fee Schedule,pays based on EAPG rates,766.22,91,,,percent of total billed charges,91% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,282.91,33.6,,,percent of total billed charges,33.6% of total billed charges,133.87,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,774.64,92,,,percent of total billed charges,92% of total billed charges,129.97,774.64,
EEG - AWAKE AND ASLEEP,6500036,CDM,740,RC,95819,HCPCS,Outpatient,,,842,715.7,,683.7,81.2,,,percent of total billed charges,81.2% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,133.87,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,639.92,76,,,percent of total billed charges,76% of total billed charges,133.87,103,,,Fee Schedule,pays based on EAPG rates,277.52,32.96,,,percent of total billed charges,32.96% of total billed charges,136.47,105,,,Fee Schedule,pays based on EAPG rates,757.8,90,,,percent of total billed charges,90% of total billed charges,757.8,90,,,percent of total billed charges,90% of total billed charges,129.97,100,,,Fee Schedule,pays based on EAPG rates,746.01,88.6,,,percent of total billed charges,88.6% of total billed charges,133.87,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,129.97,100,,,Fee Schedule,pays based on EAPG rates,766.22,91,,,percent of total billed charges,91% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,282.91,33.6,,,percent of total billed charges,33.6% of total billed charges,133.87,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,774.64,92,,,percent of total billed charges,92% of total billed charges,129.97,774.64,
NEEDLE EMG WITH CHEMODENERAVATION,6500037,CDM,922,RC,95874,HCPCS,Outpatient,,,180,153,,146.16,81.2,,,percent of total billed charges,81.2% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,136.8,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,59.33,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,162,90,,,percent of total billed charges,90% of total billed charges,162,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,159.48,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,163.8,91,,,percent of total billed charges,91% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,60.48,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,165.6,92,,,percent of total billed charges,92% of total billed charges,57.6,187.15,
NEEDLE EMG W PARASPINALS/NCV LMTD,6500038,CDM,922,RC,95885,HCPCS,Outpatient,,,180,153,,146.16,81.2,,,percent of total billed charges,81.2% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,136.8,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,59.33,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,162,90,,,percent of total billed charges,90% of total billed charges,162,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,159.48,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,163.8,91,,,percent of total billed charges,91% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,60.48,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,165.6,92,,,percent of total billed charges,92% of total billed charges,57.6,253.4,
NEEDLE EMG W PARASPINALS/NCV CMPLT,6500039,CDM,922,RC,95886,HCPCS,Outpatient,,,180,153,,146.16,81.2,,,percent of total billed charges,81.2% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,136.8,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,59.33,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,162,90,,,percent of total billed charges,90% of total billed charges,162,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,159.48,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,163.8,91,,,percent of total billed charges,91% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,60.48,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,165.6,92,,,percent of total billed charges,92% of total billed charges,57.6,253.4,
NEEDLE EMG CRANIAL NERV W NCV,6500040,CDM,922,RC,95887,HCPCS,Outpatient,,,180,153,,146.16,81.2,,,percent of total billed charges,81.2% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,133.2,74,,,percent of total billed charges,74% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,120.6,67,,,percent of total billed charges,67% of total billed charges,127.8,71,,,percent of total billed charges,71% of total billed charges,136.8,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,59.33,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,162,90,,,percent of total billed charges,90% of total billed charges,162,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,159.48,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,144,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,163.8,91,,,percent of total billed charges,91% of total billed charges,58.75,32.64,,,percent of total billed charges,32.64% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,60.48,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,57.6,32,,,percent of total billed charges,32% of total billed charges,57.6,32,,,percent of total billed charges,32% of total billed charges,165.6,92,,,percent of total billed charges,92% of total billed charges,57.6,253.4,
NERVE CONDUCTION 1-2 STUDIES,6500041,CDM,922,RC,95907,HCPCS,Outpatient,,,445,378.25,,361.34,81.2,,,percent of total billed charges,81.2% of total billed charges,145.25,32.64,,,percent of total billed charges,32.64% of total billed charges,329.3,74,,,percent of total billed charges,74% of total billed charges,329.3,74,,,percent of total billed charges,74% of total billed charges,142.4,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,142.4,32,,,percent of total billed charges,32% of total billed charges,315.95,71,,,percent of total billed charges,71% of total billed charges,315.95,71,,,percent of total billed charges,71% of total billed charges,298.15,67,,,percent of total billed charges,67% of total billed charges,298.15,67,,,percent of total billed charges,67% of total billed charges,315.95,71,,,percent of total billed charges,71% of total billed charges,338.2,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,146.67,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,400.5,90,,,percent of total billed charges,90% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,394.27,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,142.4,32,,,percent of total billed charges,32% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,404.95,91,,,percent of total billed charges,91% of total billed charges,145.25,32.64,,,percent of total billed charges,32.64% of total billed charges,142.4,32,,,percent of total billed charges,32% of total billed charges,149.52,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,142.4,32,,,percent of total billed charges,32% of total billed charges,142.4,32,,,percent of total billed charges,32% of total billed charges,409.4,92,,,percent of total billed charges,92% of total billed charges,142.4,409.4,
NERVE CONDUCTION 3-4STUDIES,6500042,CDM,922,RC,95908,HCPCS,Outpatient,,,842,715.7,,683.7,81.2,,,percent of total billed charges,81.2% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,639.92,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,277.52,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,757.8,90,,,percent of total billed charges,90% of total billed charges,757.8,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,746.01,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,766.22,91,,,percent of total billed charges,91% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,282.91,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,774.64,92,,,percent of total billed charges,92% of total billed charges,241.33,774.64,
NERVE CONDUCTION 5-6 STUDIES,6500043,CDM,922,RC,95909,HCPCS,Outpatient,,,842,715.7,,683.7,81.2,,,percent of total billed charges,81.2% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,639.92,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,277.52,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,757.8,90,,,percent of total billed charges,90% of total billed charges,757.8,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,746.01,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,766.22,91,,,percent of total billed charges,91% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,282.91,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,774.64,92,,,percent of total billed charges,92% of total billed charges,241.33,774.64,
NERVE CONDUCTION 7-8 STUDIES,6500044,CDM,922,RC,95910,HCPCS,Outpatient,,,842,715.7,,683.7,81.2,,,percent of total billed charges,81.2% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,623.08,74,,,percent of total billed charges,74% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,564.14,67,,,percent of total billed charges,67% of total billed charges,597.82,71,,,percent of total billed charges,71% of total billed charges,639.92,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,277.52,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,757.8,90,,,percent of total billed charges,90% of total billed charges,757.8,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,746.01,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,673.6,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,766.22,91,,,percent of total billed charges,91% of total billed charges,274.83,32.64,,,percent of total billed charges,32.64% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,282.91,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,269.44,32,,,percent of total billed charges,32% of total billed charges,269.44,32,,,percent of total billed charges,32% of total billed charges,774.64,92,,,percent of total billed charges,92% of total billed charges,241.33,774.64,
NERVE CONDUCTION 9-10 STUDIES,6500045,CDM,922,RC,95911,HCPCS,Outpatient,,,1552,1319.2,,1260.22,81.2,,,percent of total billed charges,81.2% of total billed charges,506.57,32.64,,,percent of total billed charges,32.64% of total billed charges,1148.48,74,,,percent of total billed charges,74% of total billed charges,1148.48,74,,,percent of total billed charges,74% of total billed charges,496.64,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,496.64,32,,,percent of total billed charges,32% of total billed charges,1101.92,71,,,percent of total billed charges,71% of total billed charges,1101.92,71,,,percent of total billed charges,71% of total billed charges,1039.84,67,,,percent of total billed charges,67% of total billed charges,1039.84,67,,,percent of total billed charges,67% of total billed charges,1101.92,71,,,percent of total billed charges,71% of total billed charges,1179.52,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,511.54,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,1396.8,90,,,percent of total billed charges,90% of total billed charges,1396.8,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,1375.07,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,496.64,32,,,percent of total billed charges,32% of total billed charges,1241.6,80,,,percent of total billed charges,80% of total billed charges,1241.6,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,1412.32,91,,,percent of total billed charges,91% of total billed charges,506.57,32.64,,,percent of total billed charges,32.64% of total billed charges,496.64,32,,,percent of total billed charges,32% of total billed charges,521.47,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,496.64,32,,,percent of total billed charges,32% of total billed charges,496.64,32,,,percent of total billed charges,32% of total billed charges,1427.84,92,,,percent of total billed charges,92% of total billed charges,241.33,1427.84,
NERVE CONDUCTION 11-12 STUDIES,6500046,CDM,922,RC,95912,HCPCS,Outpatient,,,1552,1319.2,,1260.22,81.2,,,percent of total billed charges,81.2% of total billed charges,506.57,32.64,,,percent of total billed charges,32.64% of total billed charges,1148.48,74,,,percent of total billed charges,74% of total billed charges,1148.48,74,,,percent of total billed charges,74% of total billed charges,496.64,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,496.64,32,,,percent of total billed charges,32% of total billed charges,1101.92,71,,,percent of total billed charges,71% of total billed charges,1101.92,71,,,percent of total billed charges,71% of total billed charges,1039.84,67,,,percent of total billed charges,67% of total billed charges,1039.84,67,,,percent of total billed charges,67% of total billed charges,1101.92,71,,,percent of total billed charges,71% of total billed charges,1179.52,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,511.54,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,1396.8,90,,,percent of total billed charges,90% of total billed charges,1396.8,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,1375.07,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,496.64,32,,,percent of total billed charges,32% of total billed charges,1241.6,80,,,percent of total billed charges,80% of total billed charges,1241.6,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,1412.32,91,,,percent of total billed charges,91% of total billed charges,506.57,32.64,,,percent of total billed charges,32.64% of total billed charges,496.64,32,,,percent of total billed charges,32% of total billed charges,521.47,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,496.64,32,,,percent of total billed charges,32% of total billed charges,496.64,32,,,percent of total billed charges,32% of total billed charges,1427.84,92,,,percent of total billed charges,92% of total billed charges,241.33,1427.84,
NERVE CONDUCTION 13+ STUDIES,6500047,CDM,922,RC,95913,HCPCS,Outpatient,,,1552,1319.2,,1260.22,81.2,,,percent of total billed charges,81.2% of total billed charges,506.57,32.64,,,percent of total billed charges,32.64% of total billed charges,1148.48,74,,,percent of total billed charges,74% of total billed charges,1148.48,74,,,percent of total billed charges,74% of total billed charges,496.64,32,,,percent of total billed charges,32% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,496.64,32,,,percent of total billed charges,32% of total billed charges,1101.92,71,,,percent of total billed charges,71% of total billed charges,1101.92,71,,,percent of total billed charges,71% of total billed charges,1039.84,67,,,percent of total billed charges,67% of total billed charges,1039.84,67,,,percent of total billed charges,67% of total billed charges,1101.92,71,,,percent of total billed charges,71% of total billed charges,1179.52,76,,,percent of total billed charges,76% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,511.54,32.96,,,percent of total billed charges,32.96% of total billed charges,253.4,105,,,Fee Schedule,pays based on EAPG rates,1396.8,90,,,percent of total billed charges,90% of total billed charges,1396.8,90,,,percent of total billed charges,90% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,1375.07,88.6,,,percent of total billed charges,88.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,496.64,32,,,percent of total billed charges,32% of total billed charges,1241.6,80,,,percent of total billed charges,80% of total billed charges,1241.6,80,,,percent of total billed charges,80% of total billed charges,241.33,100,,,Fee Schedule,pays based on EAPG rates,1412.32,91,,,percent of total billed charges,91% of total billed charges,506.57,32.64,,,percent of total billed charges,32.64% of total billed charges,496.64,32,,,percent of total billed charges,32% of total billed charges,521.47,33.6,,,percent of total billed charges,33.6% of total billed charges,248.57,103,,,Fee Schedule,pays based on EAPG rates,496.64,32,,,percent of total billed charges,32% of total billed charges,496.64,32,,,percent of total billed charges,32% of total billed charges,1427.84,92,,,percent of total billed charges,92% of total billed charges,241.33,1427.84,
LEVEL 2 VISIT NEW PATIENT,6500000,CDM,510,RC,99202,HCPCS,Outpatient,,,187,158.95,,151.84,81.2,,,percent of total billed charges,81.2% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,142.12,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,61.64,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,168.3,90,,,percent of total billed charges,90% of total billed charges,168.3,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,165.68,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,170.17,91,,,percent of total billed charges,91% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,62.83,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,172.04,92,,,percent of total billed charges,92% of total billed charges,42.34,172.04,
LEVEL 3 VISIT NEW PATIENT,6500001,CDM,510,RC,99203,HCPCS,Outpatient,,,281,238.85,,228.17,81.2,,,percent of total billed charges,81.2% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,213.56,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,92.62,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,252.9,90,,,percent of total billed charges,90% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,248.97,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,255.71,91,,,percent of total billed charges,91% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,94.42,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,258.52,92,,,percent of total billed charges,92% of total billed charges,42.34,258.52,
LEVEL 4 VISIT NEW PATIENT,6500002,CDM,510,RC,99204,HCPCS,Outpatient,,,347,294.95,,281.76,81.2,,,percent of total billed charges,81.2% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,263.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,114.37,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,312.3,90,,,percent of total billed charges,90% of total billed charges,312.3,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,307.44,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,315.77,91,,,percent of total billed charges,91% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,116.59,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,319.24,92,,,percent of total billed charges,92% of total billed charges,42.34,319.24,
LEVEL 5 VISIT NEW PATIENT,6500003,CDM,510,RC,99205,HCPCS,Outpatient,,,371,315.35,,301.25,81.2,,,percent of total billed charges,81.2% of total billed charges,121.09,32.64,,,percent of total billed charges,32.64% of total billed charges,274.54,74,,,percent of total billed charges,74% of total billed charges,274.54,74,,,percent of total billed charges,74% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,248.57,67,,,percent of total billed charges,67% of total billed charges,248.57,67,,,percent of total billed charges,67% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,281.96,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,122.28,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,333.9,90,,,percent of total billed charges,90% of total billed charges,333.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,328.71,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,296.8,80,,,percent of total billed charges,80% of total billed charges,296.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,337.61,91,,,percent of total billed charges,91% of total billed charges,121.09,32.64,,,percent of total billed charges,32.64% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,124.66,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,341.32,92,,,percent of total billed charges,92% of total billed charges,42.34,341.32,
LEVEL 1 VISIT EST PATIENT,6500004,CDM,510,RC,99211,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,39.04,112.24,
LEVEL 2 VISIT EST PATIENT,6500005,CDM,510,RC,99212,HCPCS,Outpatient,,,168,142.8,,136.42,81.2,,,percent of total billed charges,81.2% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,127.68,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,55.37,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,148.85,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,152.88,91,,,percent of total billed charges,91% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,56.45,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,154.56,92,,,percent of total billed charges,92% of total billed charges,42.34,154.56,
LEVEL 3 VISIT EST PATIENT,6500006,CDM,510,RC,99213,HCPCS,Outpatient,,,248,210.8,,201.38,81.2,,,percent of total billed charges,81.2% of total billed charges,80.95,32.64,,,percent of total billed charges,32.64% of total billed charges,183.52,74,,,percent of total billed charges,74% of total billed charges,183.52,74,,,percent of total billed charges,74% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,166.16,67,,,percent of total billed charges,67% of total billed charges,166.16,67,,,percent of total billed charges,67% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,188.48,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,81.74,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,223.2,90,,,percent of total billed charges,90% of total billed charges,223.2,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,219.73,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,225.68,91,,,percent of total billed charges,91% of total billed charges,80.95,32.64,,,percent of total billed charges,32.64% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,83.33,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,228.16,92,,,percent of total billed charges,92% of total billed charges,42.34,228.16,
LEVEL 4 VISIT EST PATIENT,6500007,CDM,510,RC,99214,HCPCS,Outpatient,,,291,247.35,,236.29,81.2,,,percent of total billed charges,81.2% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,221.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,95.91,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,261.9,90,,,percent of total billed charges,90% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,257.83,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,264.81,91,,,percent of total billed charges,91% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,97.78,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,267.72,92,,,percent of total billed charges,92% of total billed charges,42.34,267.72,
LEVEL 5 VISIT EST PATIENT,6500008,CDM,510,RC,99215,HCPCS,Outpatient,,,341,289.85,,276.89,81.2,,,percent of total billed charges,81.2% of total billed charges,111.3,32.64,,,percent of total billed charges,32.64% of total billed charges,252.34,74,,,percent of total billed charges,74% of total billed charges,252.34,74,,,percent of total billed charges,74% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,228.47,67,,,percent of total billed charges,67% of total billed charges,228.47,67,,,percent of total billed charges,67% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,259.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,112.39,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,306.9,90,,,percent of total billed charges,90% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,302.13,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,272.8,80,,,percent of total billed charges,80% of total billed charges,272.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,310.31,91,,,percent of total billed charges,91% of total billed charges,111.3,32.64,,,percent of total billed charges,32.64% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,114.58,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,313.72,92,,,percent of total billed charges,92% of total billed charges,42.34,313.72,
NM THYROID IMAGING WITH UPTAKE,4800058,CDM,340,RC,78014,HCPCS,Outpatient,,,499,424.15,,405.19,81.2,,,percent of total billed charges,81.2% of total billed charges,162.87,32.64,,,percent of total billed charges,32.64% of total billed charges,369.26,74,,,percent of total billed charges,74% of total billed charges,369.26,74,,,percent of total billed charges,74% of total billed charges,159.68,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,159.68,32,,,percent of total billed charges,32% of total billed charges,354.29,71,,,percent of total billed charges,71% of total billed charges,354.29,71,,,percent of total billed charges,71% of total billed charges,334.33,67,,,percent of total billed charges,67% of total billed charges,334.33,67,,,percent of total billed charges,67% of total billed charges,354.29,71,,,percent of total billed charges,71% of total billed charges,379.24,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,164.47,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,449.1,90,,,percent of total billed charges,90% of total billed charges,449.1,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,442.11,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,159.68,32,,,percent of total billed charges,32% of total billed charges,399.2,80,,,percent of total billed charges,80% of total billed charges,399.2,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,454.09,91,,,percent of total billed charges,91% of total billed charges,162.87,32.64,,,percent of total billed charges,32.64% of total billed charges,159.68,32,,,percent of total billed charges,32% of total billed charges,167.66,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,159.68,32,,,percent of total billed charges,32% of total billed charges,159.68,32,,,percent of total billed charges,32% of total billed charges,459.08,92,,,percent of total billed charges,92% of total billed charges,159.68,459.08,
NM PARATHYROID IMAGING W/ SPECT,4800042,CDM,340,RC,78071,HCPCS,Outpatient,,,526,447.1,,427.11,81.2,,,percent of total billed charges,81.2% of total billed charges,171.69,32.64,,,percent of total billed charges,32.64% of total billed charges,389.24,74,,,percent of total billed charges,74% of total billed charges,389.24,74,,,percent of total billed charges,74% of total billed charges,168.32,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,168.32,32,,,percent of total billed charges,32% of total billed charges,373.46,71,,,percent of total billed charges,71% of total billed charges,373.46,71,,,percent of total billed charges,71% of total billed charges,352.42,67,,,percent of total billed charges,67% of total billed charges,352.42,67,,,percent of total billed charges,67% of total billed charges,373.46,71,,,percent of total billed charges,71% of total billed charges,399.76,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,173.37,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,473.4,90,,,percent of total billed charges,90% of total billed charges,473.4,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,466.04,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,168.32,32,,,percent of total billed charges,32% of total billed charges,420.8,80,,,percent of total billed charges,80% of total billed charges,420.8,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,478.66,91,,,percent of total billed charges,91% of total billed charges,171.69,32.64,,,percent of total billed charges,32.64% of total billed charges,168.32,32,,,percent of total billed charges,32% of total billed charges,176.74,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,168.32,32,,,percent of total billed charges,32% of total billed charges,168.32,32,,,percent of total billed charges,32% of total billed charges,483.92,92,,,percent of total billed charges,92% of total billed charges,168.32,483.92,
NM LYMPHATIC/NODES IMAGING,4800053,CDM,340,RC,78195,HCPCS,Outpatient,,,1393,1184.05,,1131.12,81.2,,,percent of total billed charges,81.2% of total billed charges,454.68,32.64,,,percent of total billed charges,32.64% of total billed charges,1030.82,74,,,percent of total billed charges,74% of total billed charges,1030.82,74,,,percent of total billed charges,74% of total billed charges,445.76,32,,,percent of total billed charges,32% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,445.76,32,,,percent of total billed charges,32% of total billed charges,989.03,71,,,percent of total billed charges,71% of total billed charges,989.03,71,,,percent of total billed charges,71% of total billed charges,933.31,67,,,percent of total billed charges,67% of total billed charges,933.31,67,,,percent of total billed charges,67% of total billed charges,989.03,71,,,percent of total billed charges,71% of total billed charges,1058.68,76,,,percent of total billed charges,76% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,459.13,32.96,,,percent of total billed charges,32.96% of total billed charges,574.84,105,,,Fee Schedule,pays based on EAPG rates,1253.7,90,,,percent of total billed charges,90% of total billed charges,1253.7,90,,,percent of total billed charges,90% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,1234.2,88.6,,,percent of total billed charges,88.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,445.76,32,,,percent of total billed charges,32% of total billed charges,1114.4,80,,,percent of total billed charges,80% of total billed charges,1114.4,80,,,percent of total billed charges,80% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,1267.63,91,,,percent of total billed charges,91% of total billed charges,454.68,32.64,,,percent of total billed charges,32.64% of total billed charges,445.76,32,,,percent of total billed charges,32% of total billed charges,468.05,33.6,,,percent of total billed charges,33.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,445.76,32,,,percent of total billed charges,32% of total billed charges,445.76,32,,,percent of total billed charges,32% of total billed charges,1281.56,92,,,percent of total billed charges,92% of total billed charges,445.76,1281.56,
NM LIVER AND SPLEEN IMAGING,4800004,CDM,340,RC,78215,HCPCS,Outpatient,,,1057,898.45,,858.28,81.2,,,percent of total billed charges,81.2% of total billed charges,345,32.64,,,percent of total billed charges,32.64% of total billed charges,782.18,74,,,percent of total billed charges,74% of total billed charges,782.18,74,,,percent of total billed charges,74% of total billed charges,338.24,32,,,percent of total billed charges,32% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,338.24,32,,,percent of total billed charges,32% of total billed charges,750.47,71,,,percent of total billed charges,71% of total billed charges,750.47,71,,,percent of total billed charges,71% of total billed charges,708.19,67,,,percent of total billed charges,67% of total billed charges,708.19,67,,,percent of total billed charges,67% of total billed charges,750.47,71,,,percent of total billed charges,71% of total billed charges,803.32,76,,,percent of total billed charges,76% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,348.39,32.96,,,percent of total billed charges,32.96% of total billed charges,574.84,105,,,Fee Schedule,pays based on EAPG rates,951.3,90,,,percent of total billed charges,90% of total billed charges,951.3,90,,,percent of total billed charges,90% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,936.5,88.6,,,percent of total billed charges,88.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,338.24,32,,,percent of total billed charges,32% of total billed charges,845.6,80,,,percent of total billed charges,80% of total billed charges,845.6,80,,,percent of total billed charges,80% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,961.87,91,,,percent of total billed charges,91% of total billed charges,345,32.64,,,percent of total billed charges,32.64% of total billed charges,338.24,32,,,percent of total billed charges,32% of total billed charges,355.15,33.6,,,percent of total billed charges,33.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,338.24,32,,,percent of total billed charges,32% of total billed charges,338.24,32,,,percent of total billed charges,32% of total billed charges,972.44,92,,,percent of total billed charges,92% of total billed charges,338.24,972.44,
NM HIDA W/FATTY MEAL,4800059,CDM,340,RC,78226,HCPCS,Outpatient,,,1210,1028.5,,982.52,81.2,,,percent of total billed charges,81.2% of total billed charges,394.94,32.64,,,percent of total billed charges,32.64% of total billed charges,895.4,74,,,percent of total billed charges,74% of total billed charges,895.4,74,,,percent of total billed charges,74% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,810.7,67,,,percent of total billed charges,67% of total billed charges,810.7,67,,,percent of total billed charges,67% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,919.6,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,398.82,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,1089,90,,,percent of total billed charges,90% of total billed charges,1089,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1072.06,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,968,80,,,percent of total billed charges,80% of total billed charges,968,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1101.1,91,,,percent of total billed charges,91% of total billed charges,394.94,32.64,,,percent of total billed charges,32.64% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,406.56,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,1113.2,92,,,percent of total billed charges,92% of total billed charges,191.8,1113.2,
NM HIDA W/O CCK,4800023,CDM,340,RC,78226,HCPCS,Outpatient,,,1210,1028.5,,982.52,81.2,,,percent of total billed charges,81.2% of total billed charges,394.94,32.64,,,percent of total billed charges,32.64% of total billed charges,895.4,74,,,percent of total billed charges,74% of total billed charges,895.4,74,,,percent of total billed charges,74% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,810.7,67,,,percent of total billed charges,67% of total billed charges,810.7,67,,,percent of total billed charges,67% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,919.6,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,398.82,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,1089,90,,,percent of total billed charges,90% of total billed charges,1089,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1072.06,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,968,80,,,percent of total billed charges,80% of total billed charges,968,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1101.1,91,,,percent of total billed charges,91% of total billed charges,394.94,32.64,,,percent of total billed charges,32.64% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,406.56,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,1113.2,92,,,percent of total billed charges,92% of total billed charges,191.8,1113.2,
NM HIDA W/CCK,4800054,CDM,340,RC,78227,HCPCS,Outpatient,,,1210,1028.5,,982.52,81.2,,,percent of total billed charges,81.2% of total billed charges,394.94,32.64,,,percent of total billed charges,32.64% of total billed charges,895.4,74,,,percent of total billed charges,74% of total billed charges,895.4,74,,,percent of total billed charges,74% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,810.7,67,,,percent of total billed charges,67% of total billed charges,810.7,67,,,percent of total billed charges,67% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,919.6,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,398.82,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,1089,90,,,percent of total billed charges,90% of total billed charges,1089,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1072.06,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,968,80,,,percent of total billed charges,80% of total billed charges,968,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1101.1,91,,,percent of total billed charges,91% of total billed charges,394.94,32.64,,,percent of total billed charges,32.64% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,406.56,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,1113.2,92,,,percent of total billed charges,92% of total billed charges,191.8,1113.2,
NM GASTRIC EMPTY,4800041,CDM,340,RC,78264,HCPCS,Outpatient,,,1057,898.45,,858.28,81.2,,,percent of total billed charges,81.2% of total billed charges,345,32.64,,,percent of total billed charges,32.64% of total billed charges,782.18,74,,,percent of total billed charges,74% of total billed charges,782.18,74,,,percent of total billed charges,74% of total billed charges,338.24,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,338.24,32,,,percent of total billed charges,32% of total billed charges,750.47,71,,,percent of total billed charges,71% of total billed charges,750.47,71,,,percent of total billed charges,71% of total billed charges,708.19,67,,,percent of total billed charges,67% of total billed charges,708.19,67,,,percent of total billed charges,67% of total billed charges,750.47,71,,,percent of total billed charges,71% of total billed charges,803.32,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,348.39,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,951.3,90,,,percent of total billed charges,90% of total billed charges,951.3,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,936.5,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,338.24,32,,,percent of total billed charges,32% of total billed charges,845.6,80,,,percent of total billed charges,80% of total billed charges,845.6,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,961.87,91,,,percent of total billed charges,91% of total billed charges,345,32.64,,,percent of total billed charges,32.64% of total billed charges,338.24,32,,,percent of total billed charges,32% of total billed charges,355.15,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,338.24,32,,,percent of total billed charges,32% of total billed charges,338.24,32,,,percent of total billed charges,32% of total billed charges,972.44,92,,,percent of total billed charges,92% of total billed charges,191.8,972.44,
NM GI BLEEDING IMAGING,4800005,CDM,340,RC,78278,HCPCS,Outpatient,,,1070,909.5,,868.84,81.2,,,percent of total billed charges,81.2% of total billed charges,349.25,32.64,,,percent of total billed charges,32.64% of total billed charges,791.8,74,,,percent of total billed charges,74% of total billed charges,791.8,74,,,percent of total billed charges,74% of total billed charges,342.4,32,,,percent of total billed charges,32% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,342.4,32,,,percent of total billed charges,32% of total billed charges,759.7,71,,,percent of total billed charges,71% of total billed charges,759.7,71,,,percent of total billed charges,71% of total billed charges,716.9,67,,,percent of total billed charges,67% of total billed charges,716.9,67,,,percent of total billed charges,67% of total billed charges,759.7,71,,,percent of total billed charges,71% of total billed charges,813.2,76,,,percent of total billed charges,76% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,352.67,32.96,,,percent of total billed charges,32.96% of total billed charges,574.84,105,,,Fee Schedule,pays based on EAPG rates,963,90,,,percent of total billed charges,90% of total billed charges,963,90,,,percent of total billed charges,90% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,948.02,88.6,,,percent of total billed charges,88.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,342.4,32,,,percent of total billed charges,32% of total billed charges,856,80,,,percent of total billed charges,80% of total billed charges,856,80,,,percent of total billed charges,80% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,973.7,91,,,percent of total billed charges,91% of total billed charges,349.25,32.64,,,percent of total billed charges,32.64% of total billed charges,342.4,32,,,percent of total billed charges,32% of total billed charges,359.52,33.6,,,percent of total billed charges,33.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,342.4,32,,,percent of total billed charges,32% of total billed charges,342.4,32,,,percent of total billed charges,32% of total billed charges,984.4,92,,,percent of total billed charges,92% of total billed charges,342.4,984.4,
NM BONE/JOINT IMAGE LIMITED AREA,4800016,CDM,340,RC,78300,HCPCS,Outpatient,,,808,686.8,,656.1,81.2,,,percent of total billed charges,81.2% of total billed charges,263.73,32.64,,,percent of total billed charges,32.64% of total billed charges,597.92,74,,,percent of total billed charges,74% of total billed charges,597.92,74,,,percent of total billed charges,74% of total billed charges,258.56,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,258.56,32,,,percent of total billed charges,32% of total billed charges,573.68,71,,,percent of total billed charges,71% of total billed charges,573.68,71,,,percent of total billed charges,71% of total billed charges,541.36,67,,,percent of total billed charges,67% of total billed charges,541.36,67,,,percent of total billed charges,67% of total billed charges,573.68,71,,,percent of total billed charges,71% of total billed charges,614.08,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,266.32,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,727.2,90,,,percent of total billed charges,90% of total billed charges,727.2,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,715.89,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,258.56,32,,,percent of total billed charges,32% of total billed charges,646.4,80,,,percent of total billed charges,80% of total billed charges,646.4,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,735.28,91,,,percent of total billed charges,91% of total billed charges,263.73,32.64,,,percent of total billed charges,32.64% of total billed charges,258.56,32,,,percent of total billed charges,32% of total billed charges,271.49,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,258.56,32,,,percent of total billed charges,32% of total billed charges,258.56,32,,,percent of total billed charges,32% of total billed charges,743.36,92,,,percent of total billed charges,92% of total billed charges,191.8,743.36,
NM BONE/JOINT IMAG. WHOLE BODY,4800013,CDM,340,RC,78306,HCPCS,Outpatient,,,808,686.8,,656.1,81.2,,,percent of total billed charges,81.2% of total billed charges,263.73,32.64,,,percent of total billed charges,32.64% of total billed charges,597.92,74,,,percent of total billed charges,74% of total billed charges,597.92,74,,,percent of total billed charges,74% of total billed charges,258.56,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,258.56,32,,,percent of total billed charges,32% of total billed charges,573.68,71,,,percent of total billed charges,71% of total billed charges,573.68,71,,,percent of total billed charges,71% of total billed charges,541.36,67,,,percent of total billed charges,67% of total billed charges,541.36,67,,,percent of total billed charges,67% of total billed charges,573.68,71,,,percent of total billed charges,71% of total billed charges,614.08,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,266.32,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,727.2,90,,,percent of total billed charges,90% of total billed charges,727.2,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,715.89,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,258.56,32,,,percent of total billed charges,32% of total billed charges,646.4,80,,,percent of total billed charges,80% of total billed charges,646.4,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,735.28,91,,,percent of total billed charges,91% of total billed charges,263.73,32.64,,,percent of total billed charges,32.64% of total billed charges,258.56,32,,,percent of total billed charges,32% of total billed charges,271.49,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,258.56,32,,,percent of total billed charges,32% of total billed charges,258.56,32,,,percent of total billed charges,32% of total billed charges,743.36,92,,,percent of total billed charges,92% of total billed charges,191.8,743.36,
NM BONE/JOINT IMAG 3 PHASE,4800015,CDM,340,RC,78315,HCPCS,Outpatient,,,891,757.35,,723.49,81.2,,,percent of total billed charges,81.2% of total billed charges,290.82,32.64,,,percent of total billed charges,32.64% of total billed charges,659.34,74,,,percent of total billed charges,74% of total billed charges,659.34,74,,,percent of total billed charges,74% of total billed charges,285.12,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,285.12,32,,,percent of total billed charges,32% of total billed charges,632.61,71,,,percent of total billed charges,71% of total billed charges,632.61,71,,,percent of total billed charges,71% of total billed charges,596.97,67,,,percent of total billed charges,67% of total billed charges,596.97,67,,,percent of total billed charges,67% of total billed charges,632.61,71,,,percent of total billed charges,71% of total billed charges,677.16,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,293.67,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,801.9,90,,,percent of total billed charges,90% of total billed charges,801.9,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,789.43,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,285.12,32,,,percent of total billed charges,32% of total billed charges,712.8,80,,,percent of total billed charges,80% of total billed charges,712.8,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,810.81,91,,,percent of total billed charges,91% of total billed charges,290.82,32.64,,,percent of total billed charges,32.64% of total billed charges,285.12,32,,,percent of total billed charges,32% of total billed charges,299.38,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,285.12,32,,,percent of total billed charges,32% of total billed charges,285.12,32,,,percent of total billed charges,32% of total billed charges,819.72,92,,,percent of total billed charges,92% of total billed charges,191.8,819.72,
NM MYOCARD PERF SPECT  SINGLE,4800030,CDM,340,RC,78451,HCPCS,Outpatient,,,2342,1990.7,,1901.7,81.2,,,percent of total billed charges,81.2% of total billed charges,764.43,32.64,,,percent of total billed charges,32.64% of total billed charges,1733.08,74,,,percent of total billed charges,74% of total billed charges,1733.08,74,,,percent of total billed charges,74% of total billed charges,749.44,32,,,percent of total billed charges,32% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,749.44,32,,,percent of total billed charges,32% of total billed charges,1662.82,71,,,percent of total billed charges,71% of total billed charges,1662.82,71,,,percent of total billed charges,71% of total billed charges,1569.14,67,,,percent of total billed charges,67% of total billed charges,1569.14,67,,,percent of total billed charges,67% of total billed charges,1662.82,71,,,percent of total billed charges,71% of total billed charges,1779.92,76,,,percent of total billed charges,76% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,771.92,32.96,,,percent of total billed charges,32.96% of total billed charges,574.84,105,,,Fee Schedule,pays based on EAPG rates,2107.8,90,,,percent of total billed charges,90% of total billed charges,2107.8,90,,,percent of total billed charges,90% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,2075.01,88.6,,,percent of total billed charges,88.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,749.44,32,,,percent of total billed charges,32% of total billed charges,1873.6,80,,,percent of total billed charges,80% of total billed charges,1873.6,80,,,percent of total billed charges,80% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,2131.22,91,,,percent of total billed charges,91% of total billed charges,764.43,32.64,,,percent of total billed charges,32.64% of total billed charges,749.44,32,,,percent of total billed charges,32% of total billed charges,786.91,33.6,,,percent of total billed charges,33.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,749.44,32,,,percent of total billed charges,32% of total billed charges,749.44,32,,,percent of total billed charges,32% of total billed charges,2154.64,92,,,percent of total billed charges,92% of total billed charges,547.47,2154.64,
NM MYOCARD PERF SPECT MULT.STU,4800009,CDM,340,RC,78452,HCPCS,Outpatient,,,3515,2987.75,,2854.18,81.2,,,percent of total billed charges,81.2% of total billed charges,1147.3,32.64,,,percent of total billed charges,32.64% of total billed charges,2601.1,74,,,percent of total billed charges,74% of total billed charges,2601.1,74,,,percent of total billed charges,74% of total billed charges,1124.8,32,,,percent of total billed charges,32% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,1124.8,32,,,percent of total billed charges,32% of total billed charges,2495.65,71,,,percent of total billed charges,71% of total billed charges,2495.65,71,,,percent of total billed charges,71% of total billed charges,2355.05,67,,,percent of total billed charges,67% of total billed charges,2355.05,67,,,percent of total billed charges,67% of total billed charges,2495.65,71,,,percent of total billed charges,71% of total billed charges,2671.4,76,,,percent of total billed charges,76% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,1158.54,32.96,,,percent of total billed charges,32.96% of total billed charges,574.84,105,,,Fee Schedule,pays based on EAPG rates,3163.5,90,,,percent of total billed charges,90% of total billed charges,3163.5,90,,,percent of total billed charges,90% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,3114.29,88.6,,,percent of total billed charges,88.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,1124.8,32,,,percent of total billed charges,32% of total billed charges,2812,80,,,percent of total billed charges,80% of total billed charges,2812,80,,,percent of total billed charges,80% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,3198.65,91,,,percent of total billed charges,91% of total billed charges,1147.3,32.64,,,percent of total billed charges,32.64% of total billed charges,1124.8,32,,,percent of total billed charges,32% of total billed charges,1181.04,33.6,,,percent of total billed charges,33.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,1124.8,32,,,percent of total billed charges,32% of total billed charges,1124.8,32,,,percent of total billed charges,32% of total billed charges,3233.8,92,,,percent of total billed charges,92% of total billed charges,547.47,3233.8,
NM MUGA,4800028,CDM,340,RC,78472,HCPCS,Outpatient,,,967,821.95,,785.2,81.2,,,percent of total billed charges,81.2% of total billed charges,315.63,32.64,,,percent of total billed charges,32.64% of total billed charges,715.58,74,,,percent of total billed charges,74% of total billed charges,715.58,74,,,percent of total billed charges,74% of total billed charges,309.44,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,309.44,32,,,percent of total billed charges,32% of total billed charges,686.57,71,,,percent of total billed charges,71% of total billed charges,686.57,71,,,percent of total billed charges,71% of total billed charges,647.89,67,,,percent of total billed charges,67% of total billed charges,647.89,67,,,percent of total billed charges,67% of total billed charges,686.57,71,,,percent of total billed charges,71% of total billed charges,734.92,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,318.72,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,870.3,90,,,percent of total billed charges,90% of total billed charges,870.3,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,856.76,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,309.44,32,,,percent of total billed charges,32% of total billed charges,773.6,80,,,percent of total billed charges,80% of total billed charges,773.6,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,879.97,91,,,percent of total billed charges,91% of total billed charges,315.63,32.64,,,percent of total billed charges,32.64% of total billed charges,309.44,32,,,percent of total billed charges,32% of total billed charges,324.91,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,309.44,32,,,percent of total billed charges,32% of total billed charges,309.44,32,,,percent of total billed charges,32% of total billed charges,889.64,92,,,percent of total billed charges,92% of total billed charges,191.8,889.64,
NM PULMONARY VENTILATION IMAGING,4800021,CDM,340,RC,78579,HCPCS,Outpatient,,,877,745.45,,712.12,81.2,,,percent of total billed charges,81.2% of total billed charges,286.25,32.64,,,percent of total billed charges,32.64% of total billed charges,648.98,74,,,percent of total billed charges,74% of total billed charges,648.98,74,,,percent of total billed charges,74% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,587.59,67,,,percent of total billed charges,67% of total billed charges,587.59,67,,,percent of total billed charges,67% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,666.52,76,,,percent of total billed charges,76% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,289.06,32.96,,,percent of total billed charges,32.96% of total billed charges,574.84,105,,,Fee Schedule,pays based on EAPG rates,789.3,90,,,percent of total billed charges,90% of total billed charges,789.3,90,,,percent of total billed charges,90% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,777.02,88.6,,,percent of total billed charges,88.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,701.6,80,,,percent of total billed charges,80% of total billed charges,701.6,80,,,percent of total billed charges,80% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,798.07,91,,,percent of total billed charges,91% of total billed charges,286.25,32.64,,,percent of total billed charges,32.64% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,294.67,33.6,,,percent of total billed charges,33.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,806.84,92,,,percent of total billed charges,92% of total billed charges,280.64,806.84,
NM PULMONARY PERFUSION IMAGING,4800019,CDM,340,RC,78580,HCPCS,Outpatient,,,877,745.45,,712.12,81.2,,,percent of total billed charges,81.2% of total billed charges,286.25,32.64,,,percent of total billed charges,32.64% of total billed charges,648.98,74,,,percent of total billed charges,74% of total billed charges,648.98,74,,,percent of total billed charges,74% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,587.59,67,,,percent of total billed charges,67% of total billed charges,587.59,67,,,percent of total billed charges,67% of total billed charges,622.67,71,,,percent of total billed charges,71% of total billed charges,666.52,76,,,percent of total billed charges,76% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,289.06,32.96,,,percent of total billed charges,32.96% of total billed charges,574.84,105,,,Fee Schedule,pays based on EAPG rates,789.3,90,,,percent of total billed charges,90% of total billed charges,789.3,90,,,percent of total billed charges,90% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,777.02,88.6,,,percent of total billed charges,88.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,701.6,80,,,percent of total billed charges,80% of total billed charges,701.6,80,,,percent of total billed charges,80% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,798.07,91,,,percent of total billed charges,91% of total billed charges,286.25,32.64,,,percent of total billed charges,32.64% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,294.67,33.6,,,percent of total billed charges,33.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,280.64,32,,,percent of total billed charges,32% of total billed charges,280.64,32,,,percent of total billed charges,32% of total billed charges,806.84,92,,,percent of total billed charges,92% of total billed charges,280.64,806.84,
NM VQ PULM.PERF/VENT MULTI,4800048,CDM,340,RC,78582,HCPCS,Outpatient,,,2143,1821.55,,1740.12,81.2,,,percent of total billed charges,81.2% of total billed charges,699.48,32.64,,,percent of total billed charges,32.64% of total billed charges,1585.82,74,,,percent of total billed charges,74% of total billed charges,1585.82,74,,,percent of total billed charges,74% of total billed charges,685.76,32,,,percent of total billed charges,32% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,685.76,32,,,percent of total billed charges,32% of total billed charges,1521.53,71,,,percent of total billed charges,71% of total billed charges,1521.53,71,,,percent of total billed charges,71% of total billed charges,1435.81,67,,,percent of total billed charges,67% of total billed charges,1435.81,67,,,percent of total billed charges,67% of total billed charges,1521.53,71,,,percent of total billed charges,71% of total billed charges,1628.68,76,,,percent of total billed charges,76% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,706.33,32.96,,,percent of total billed charges,32.96% of total billed charges,574.84,105,,,Fee Schedule,pays based on EAPG rates,1928.7,90,,,percent of total billed charges,90% of total billed charges,1928.7,90,,,percent of total billed charges,90% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,1898.7,88.6,,,percent of total billed charges,88.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,685.76,32,,,percent of total billed charges,32% of total billed charges,1714.4,80,,,percent of total billed charges,80% of total billed charges,1714.4,80,,,percent of total billed charges,80% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,1950.13,91,,,percent of total billed charges,91% of total billed charges,699.48,32.64,,,percent of total billed charges,32.64% of total billed charges,685.76,32,,,percent of total billed charges,32% of total billed charges,720.05,33.6,,,percent of total billed charges,33.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,685.76,32,,,percent of total billed charges,32% of total billed charges,685.76,32,,,percent of total billed charges,32% of total billed charges,1971.56,92,,,percent of total billed charges,92% of total billed charges,547.47,1971.56,
NM RENAL SCAN FLOW/FUNCT SNGL W/O PHARM,4800025,CDM,340,RC,78707,HCPCS,Outpatient,,,1210,1028.5,,982.52,81.2,,,percent of total billed charges,81.2% of total billed charges,394.94,32.64,,,percent of total billed charges,32.64% of total billed charges,895.4,74,,,percent of total billed charges,74% of total billed charges,895.4,74,,,percent of total billed charges,74% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,810.7,67,,,percent of total billed charges,67% of total billed charges,810.7,67,,,percent of total billed charges,67% of total billed charges,859.1,71,,,percent of total billed charges,71% of total billed charges,919.6,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,398.82,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,1089,90,,,percent of total billed charges,90% of total billed charges,1089,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1072.06,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,968,80,,,percent of total billed charges,80% of total billed charges,968,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1101.1,91,,,percent of total billed charges,91% of total billed charges,394.94,32.64,,,percent of total billed charges,32.64% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,406.56,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,387.2,32,,,percent of total billed charges,32% of total billed charges,387.2,32,,,percent of total billed charges,32% of total billed charges,1113.2,92,,,percent of total billed charges,92% of total billed charges,191.8,1113.2,
NM RENAL SCAN FLOW/FUNCT SNGL W/ PHARM,4800045,CDM,340,RC,78708,HCPCS,Outpatient,,,1214,1031.9,,985.77,81.2,,,percent of total billed charges,81.2% of total billed charges,396.25,32.64,,,percent of total billed charges,32.64% of total billed charges,898.36,74,,,percent of total billed charges,74% of total billed charges,898.36,74,,,percent of total billed charges,74% of total billed charges,388.48,32,,,percent of total billed charges,32% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,388.48,32,,,percent of total billed charges,32% of total billed charges,861.94,71,,,percent of total billed charges,71% of total billed charges,861.94,71,,,percent of total billed charges,71% of total billed charges,813.38,67,,,percent of total billed charges,67% of total billed charges,813.38,67,,,percent of total billed charges,67% of total billed charges,861.94,71,,,percent of total billed charges,71% of total billed charges,922.64,76,,,percent of total billed charges,76% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,400.13,32.96,,,percent of total billed charges,32.96% of total billed charges,201.39,105,,,Fee Schedule,pays based on EAPG rates,1092.6,90,,,percent of total billed charges,90% of total billed charges,1092.6,90,,,percent of total billed charges,90% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1075.6,88.6,,,percent of total billed charges,88.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,388.48,32,,,percent of total billed charges,32% of total billed charges,971.2,80,,,percent of total billed charges,80% of total billed charges,971.2,80,,,percent of total billed charges,80% of total billed charges,191.8,100,,,Fee Schedule,pays based on EAPG rates,1104.74,91,,,percent of total billed charges,91% of total billed charges,396.25,32.64,,,percent of total billed charges,32.64% of total billed charges,388.48,32,,,percent of total billed charges,32% of total billed charges,407.9,33.6,,,percent of total billed charges,33.6% of total billed charges,197.55,103,,,Fee Schedule,pays based on EAPG rates,388.48,32,,,percent of total billed charges,32% of total billed charges,388.48,32,,,percent of total billed charges,32% of total billed charges,1116.88,92,,,percent of total billed charges,92% of total billed charges,191.8,1116.88,
NM BONE/JT IMAGE TOMOGRAPHSPECT,4800033,CDM,340,RC,78803,HCPCS,Outpatient,,,811,689.35,,658.53,81.2,,,percent of total billed charges,81.2% of total billed charges,264.71,32.64,,,percent of total billed charges,32.64% of total billed charges,600.14,74,,,percent of total billed charges,74% of total billed charges,600.14,74,,,percent of total billed charges,74% of total billed charges,259.52,32,,,percent of total billed charges,32% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,259.52,32,,,percent of total billed charges,32% of total billed charges,575.81,71,,,percent of total billed charges,71% of total billed charges,575.81,71,,,percent of total billed charges,71% of total billed charges,543.37,67,,,percent of total billed charges,67% of total billed charges,543.37,67,,,percent of total billed charges,67% of total billed charges,575.81,71,,,percent of total billed charges,71% of total billed charges,616.36,76,,,percent of total billed charges,76% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,267.31,32.96,,,percent of total billed charges,32.96% of total billed charges,574.84,105,,,Fee Schedule,pays based on EAPG rates,729.9,90,,,percent of total billed charges,90% of total billed charges,729.9,90,,,percent of total billed charges,90% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,718.55,88.6,,,percent of total billed charges,88.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,259.52,32,,,percent of total billed charges,32% of total billed charges,648.8,80,,,percent of total billed charges,80% of total billed charges,648.8,80,,,percent of total billed charges,80% of total billed charges,547.47,100,,,Fee Schedule,pays based on EAPG rates,738.01,91,,,percent of total billed charges,91% of total billed charges,264.71,32.64,,,percent of total billed charges,32.64% of total billed charges,259.52,32,,,percent of total billed charges,32% of total billed charges,272.5,33.6,,,percent of total billed charges,33.6% of total billed charges,563.89,103,,,Fee Schedule,pays based on EAPG rates,259.52,32,,,percent of total billed charges,32% of total billed charges,259.52,32,,,percent of total billed charges,32% of total billed charges,746.12,92,,,percent of total billed charges,92% of total billed charges,259.52,746.12,
CARDIOL.SESTAMIBI Tc99m 2 DOSE,4800052,CDM,343,RC,A9500,HCPCS,Outpatient,,,1049,891.65,,851.79,81.2,,,percent of total billed charges,81.2% of total billed charges,342.39,32.64,,,percent of total billed charges,32.64% of total billed charges,776.26,74,,,percent of total billed charges,74% of total billed charges,776.26,74,,,percent of total billed charges,74% of total billed charges,335.68,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,335.68,32,,,percent of total billed charges,32% of total billed charges,744.79,71,,,percent of total billed charges,71% of total billed charges,744.79,71,,,percent of total billed charges,71% of total billed charges,702.83,67,,,percent of total billed charges,67% of total billed charges,702.83,67,,,percent of total billed charges,67% of total billed charges,744.79,71,,,percent of total billed charges,71% of total billed charges,797.24,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,345.75,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,944.1,90,,,percent of total billed charges,90% of total billed charges,944.1,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,929.41,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,335.68,32,,,percent of total billed charges,32% of total billed charges,839.2,80,,,percent of total billed charges,80% of total billed charges,839.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,954.59,91,,,percent of total billed charges,91% of total billed charges,342.39,32.64,,,percent of total billed charges,32.64% of total billed charges,335.68,32,,,percent of total billed charges,32% of total billed charges,352.46,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,335.68,32,,,percent of total billed charges,32% of total billed charges,335.68,32,,,percent of total billed charges,32% of total billed charges,965.08,92,,,percent of total billed charges,92% of total billed charges,79.78,965.08,
CARDIOLITE DIAGNOSTIC INJECTIO,4800031,CDM,250,RC,A9500,HCPCS,Outpatient,,,1174,997.9,,953.29,81.2,,,percent of total billed charges,81.2% of total billed charges,383.19,32.64,,,percent of total billed charges,32.64% of total billed charges,868.76,74,,,percent of total billed charges,74% of total billed charges,868.76,74,,,percent of total billed charges,74% of total billed charges,375.68,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,375.68,32,,,percent of total billed charges,32% of total billed charges,833.54,71,,,percent of total billed charges,71% of total billed charges,833.54,71,,,percent of total billed charges,71% of total billed charges,786.58,67,,,percent of total billed charges,67% of total billed charges,786.58,67,,,percent of total billed charges,67% of total billed charges,833.54,71,,,percent of total billed charges,71% of total billed charges,892.24,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,386.95,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,1056.6,90,,,percent of total billed charges,90% of total billed charges,1056.6,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,1040.16,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,375.68,32,,,percent of total billed charges,32% of total billed charges,939.2,80,,,percent of total billed charges,80% of total billed charges,939.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,1068.34,91,,,percent of total billed charges,91% of total billed charges,383.19,32.64,,,percent of total billed charges,32.64% of total billed charges,375.68,32,,,percent of total billed charges,32% of total billed charges,394.46,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,375.68,32,,,percent of total billed charges,32% of total billed charges,375.68,32,,,percent of total billed charges,32% of total billed charges,1080.08,92,,,percent of total billed charges,92% of total billed charges,79.78,1080.08,
TC MYOVIEW DIAGN INJECTION-1 DOSE,4800055,CDM,250,RC,A9502,HCPCS,Outpatient,,,861,731.85,,699.13,81.2,,,percent of total billed charges,81.2% of total billed charges,281.03,32.64,,,percent of total billed charges,32.64% of total billed charges,637.14,74,,,percent of total billed charges,74% of total billed charges,637.14,74,,,percent of total billed charges,74% of total billed charges,275.52,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,275.52,32,,,percent of total billed charges,32% of total billed charges,611.31,71,,,percent of total billed charges,71% of total billed charges,611.31,71,,,percent of total billed charges,71% of total billed charges,576.87,67,,,percent of total billed charges,67% of total billed charges,576.87,67,,,percent of total billed charges,67% of total billed charges,611.31,71,,,percent of total billed charges,71% of total billed charges,654.36,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,283.79,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,774.9,90,,,percent of total billed charges,90% of total billed charges,774.9,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,762.85,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,275.52,32,,,percent of total billed charges,32% of total billed charges,688.8,80,,,percent of total billed charges,80% of total billed charges,688.8,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,783.51,91,,,percent of total billed charges,91% of total billed charges,281.03,32.64,,,percent of total billed charges,32.64% of total billed charges,275.52,32,,,percent of total billed charges,32% of total billed charges,289.3,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,275.52,32,,,percent of total billed charges,32% of total billed charges,275.52,32,,,percent of total billed charges,32% of total billed charges,792.12,92,,,percent of total billed charges,92% of total billed charges,79.78,792.12,
TC MYOVIEW DIAGN INJECTION-2 DOSE,4800032,CDM,343,RC,A9502,HCPCS,Outpatient,,,1984,1686.4,,1611.01,81.2,,,percent of total billed charges,81.2% of total billed charges,647.58,32.64,,,percent of total billed charges,32.64% of total billed charges,1468.16,74,,,percent of total billed charges,74% of total billed charges,1468.16,74,,,percent of total billed charges,74% of total billed charges,634.88,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,634.88,32,,,percent of total billed charges,32% of total billed charges,1408.64,71,,,percent of total billed charges,71% of total billed charges,1408.64,71,,,percent of total billed charges,71% of total billed charges,1329.28,67,,,percent of total billed charges,67% of total billed charges,1329.28,67,,,percent of total billed charges,67% of total billed charges,1408.64,71,,,percent of total billed charges,71% of total billed charges,1507.84,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,653.93,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,1785.6,90,,,percent of total billed charges,90% of total billed charges,1785.6,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,1757.82,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,634.88,32,,,percent of total billed charges,32% of total billed charges,1587.2,80,,,percent of total billed charges,80% of total billed charges,1587.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,1805.44,91,,,percent of total billed charges,91% of total billed charges,647.58,32.64,,,percent of total billed charges,32.64% of total billed charges,634.88,32,,,percent of total billed charges,32% of total billed charges,666.62,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,634.88,32,,,percent of total billed charges,32% of total billed charges,634.88,32,,,percent of total billed charges,32% of total billed charges,1825.28,92,,,percent of total billed charges,92% of total billed charges,79.78,1825.28,
Tc99m MDP DIAG. INJECTION,4800014,CDM,343,RC,A9503,HCPCS,Outpatient,,,579,492.15,,470.15,81.2,,,percent of total billed charges,81.2% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,440.04,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,190.84,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,521.1,90,,,percent of total billed charges,90% of total billed charges,521.1,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,512.99,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,526.89,91,,,percent of total billed charges,91% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,194.54,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,532.68,92,,,percent of total billed charges,92% of total billed charges,79.78,532.68,
Tc99m DISOFENIN DIAG INJECT,4800024,CDM,343,RC,A9510,HCPCS,Outpatient,,,579,492.15,,470.15,81.2,,,percent of total billed charges,81.2% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,440.04,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,190.84,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,521.1,90,,,percent of total billed charges,90% of total billed charges,521.1,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,512.99,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,526.89,91,,,percent of total billed charges,91% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,194.54,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,532.68,92,,,percent of total billed charges,92% of total billed charges,79.78,532.68,
I 123 CAPSULES,4800018,CDM,255,RC,A9516,HCPCS,Outpatient,,,414,351.9,,336.17,81.2,,,percent of total billed charges,81.2% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,314.64,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,136.45,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,372.6,90,,,percent of total billed charges,90% of total billed charges,372.6,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,366.8,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,376.74,91,,,percent of total billed charges,91% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,139.1,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,380.88,92,,,percent of total billed charges,92% of total billed charges,79.78,380.88,
LYMPHOSEEK,4800060,CDM,343,RC,A9520,HCPCS,Outpatient,,,2052,1744.2,,1666.22,81.2,,,percent of total billed charges,81.2% of total billed charges,669.77,32.64,,,percent of total billed charges,32.64% of total billed charges,1518.48,74,,,percent of total billed charges,74% of total billed charges,1518.48,74,,,percent of total billed charges,74% of total billed charges,656.64,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,656.64,32,,,percent of total billed charges,32% of total billed charges,1456.92,71,,,percent of total billed charges,71% of total billed charges,1456.92,71,,,percent of total billed charges,71% of total billed charges,1374.84,67,,,percent of total billed charges,67% of total billed charges,1374.84,67,,,percent of total billed charges,67% of total billed charges,1456.92,71,,,percent of total billed charges,71% of total billed charges,1559.52,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,676.34,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,1846.8,90,,,percent of total billed charges,90% of total billed charges,1846.8,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,1818.07,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,656.64,32,,,percent of total billed charges,32% of total billed charges,1641.6,80,,,percent of total billed charges,80% of total billed charges,1641.6,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,1867.32,91,,,percent of total billed charges,91% of total billed charges,669.77,32.64,,,percent of total billed charges,32.64% of total billed charges,656.64,32,,,percent of total billed charges,32% of total billed charges,689.47,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,656.64,32,,,percent of total billed charges,32% of total billed charges,656.64,32,,,percent of total billed charges,32% of total billed charges,1887.84,92,,,percent of total billed charges,92% of total billed charges,79.78,1887.84,
CERETEC INJECTION,4800037,CDM,250,RC,A9521,HCPCS,Outpatient,,,2559,2175.15,,2077.91,81.2,,,percent of total billed charges,81.2% of total billed charges,835.26,32.64,,,percent of total billed charges,32.64% of total billed charges,1893.66,74,,,percent of total billed charges,74% of total billed charges,1893.66,74,,,percent of total billed charges,74% of total billed charges,818.88,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,818.88,32,,,percent of total billed charges,32% of total billed charges,1816.89,71,,,percent of total billed charges,71% of total billed charges,1816.89,71,,,percent of total billed charges,71% of total billed charges,1714.53,67,,,percent of total billed charges,67% of total billed charges,1714.53,67,,,percent of total billed charges,67% of total billed charges,1816.89,71,,,percent of total billed charges,71% of total billed charges,1944.84,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,843.45,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,2303.1,90,,,percent of total billed charges,90% of total billed charges,2303.1,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,2267.27,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,818.88,32,,,percent of total billed charges,32% of total billed charges,2047.2,80,,,percent of total billed charges,80% of total billed charges,2047.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,2328.69,91,,,percent of total billed charges,91% of total billed charges,835.26,32.64,,,percent of total billed charges,32.64% of total billed charges,818.88,32,,,percent of total billed charges,32% of total billed charges,859.82,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,818.88,32,,,percent of total billed charges,32% of total billed charges,818.88,32,,,percent of total billed charges,32% of total billed charges,2354.28,92,,,percent of total billed charges,92% of total billed charges,79.78,2354.28,
TCM99NAT04 DIAG. INJECTION,4800036,CDM,255,RC,A9538,HCPCS,Outpatient,,,414,351.9,,336.17,81.2,,,percent of total billed charges,81.2% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,314.64,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,136.45,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,372.6,90,,,percent of total billed charges,90% of total billed charges,372.6,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,366.8,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,376.74,91,,,percent of total billed charges,91% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,139.1,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,380.88,92,,,percent of total billed charges,92% of total billed charges,79.78,380.88,
Tc99m DTPA DIAG INJECT,4800020,CDM,343,RC,A9539,HCPCS,Outpatient,,,579,492.15,,470.15,81.2,,,percent of total billed charges,81.2% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,440.04,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,190.84,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,521.1,90,,,percent of total billed charges,90% of total billed charges,521.1,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,512.99,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,526.89,91,,,percent of total billed charges,91% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,194.54,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,532.68,92,,,percent of total billed charges,92% of total billed charges,79.78,532.68,
Tc99m MAA DIAG INJECTION,4800022,CDM,343,RC,A9540,HCPCS,Outpatient,,,579,492.15,,470.15,81.2,,,percent of total billed charges,81.2% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,440.04,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,190.84,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,521.1,90,,,percent of total billed charges,90% of total billed charges,521.1,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,512.99,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,526.89,91,,,percent of total billed charges,91% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,194.54,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,532.68,92,,,percent of total billed charges,92% of total billed charges,79.78,532.68,
Tc99m SULFAR COLLOID DIAG INJ,4800012,CDM,255,RC,A9541,HCPCS,Outpatient,,,414,351.9,,336.17,81.2,,,percent of total billed charges,81.2% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,306.36,74,,,percent of total billed charges,74% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,277.38,67,,,percent of total billed charges,67% of total billed charges,293.94,71,,,percent of total billed charges,71% of total billed charges,314.64,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,136.45,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,372.6,90,,,percent of total billed charges,90% of total billed charges,372.6,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,366.8,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,331.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,376.74,91,,,percent of total billed charges,91% of total billed charges,135.13,32.64,,,percent of total billed charges,32.64% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,139.1,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,132.48,32,,,percent of total billed charges,32% of total billed charges,132.48,32,,,percent of total billed charges,32% of total billed charges,380.88,92,,,percent of total billed charges,92% of total billed charges,79.78,380.88,
Tc99MAG 3 DIAG INJECTION,4800027,CDM,250,RC,A9562,HCPCS,Outpatient,,,579,492.15,,470.15,81.2,,,percent of total billed charges,81.2% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,428.46,74,,,percent of total billed charges,74% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,387.93,67,,,percent of total billed charges,67% of total billed charges,411.09,71,,,percent of total billed charges,71% of total billed charges,440.04,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,190.84,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,521.1,90,,,percent of total billed charges,90% of total billed charges,521.1,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,512.99,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,463.2,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,526.89,91,,,percent of total billed charges,91% of total billed charges,188.99,32.64,,,percent of total billed charges,32.64% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,194.54,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,185.28,32,,,percent of total billed charges,32% of total billed charges,185.28,32,,,percent of total billed charges,32% of total billed charges,532.68,92,,,percent of total billed charges,92% of total billed charges,79.78,532.68,
OT ESTIM SUPV,3600012,CDM,430,RC,97014,HCPCS,Outpatient,,,142,120.7,,115.3,81.2,,,percent of total billed charges,81.2% of total billed charges,46.35,32.64,,,percent of total billed charges,32.64% of total billed charges,105.08,74,,,percent of total billed charges,74% of total billed charges,105.08,74,,,percent of total billed charges,74% of total billed charges,45.44,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,45.44,32,,,percent of total billed charges,32% of total billed charges,100.82,71,,,percent of total billed charges,71% of total billed charges,100.82,71,,,percent of total billed charges,71% of total billed charges,95.14,67,,,percent of total billed charges,67% of total billed charges,95.14,67,,,percent of total billed charges,67% of total billed charges,100.82,71,,,percent of total billed charges,71% of total billed charges,107.92,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,46.8,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,127.8,90,,,percent of total billed charges,90% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,125.81,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,45.44,32,,,percent of total billed charges,32% of total billed charges,113.6,80,,,percent of total billed charges,80% of total billed charges,113.6,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,129.22,91,,,percent of total billed charges,91% of total billed charges,46.35,32.64,,,percent of total billed charges,32.64% of total billed charges,45.44,32,,,percent of total billed charges,32% of total billed charges,47.71,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,45.44,32,,,percent of total billed charges,32% of total billed charges,45.44,32,,,percent of total billed charges,32% of total billed charges,130.64,92,,,percent of total billed charges,92% of total billed charges,19.16,130.64,
OT PARAFFIN BATH,3600042,CDM,430,RC,97018,HCPCS,Outpatient,,,135,114.75,,109.62,81.2,,,percent of total billed charges,81.2% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,102.6,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,44.5,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,119.61,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,122.85,91,,,percent of total billed charges,91% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,45.36,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,124.2,92,,,percent of total billed charges,92% of total billed charges,19.16,124.2,
OT LASER THERAPY,3600027,CDM,430,RC,97026,HCPCS,Outpatient,,,40,34,,32.48,81.2,,,percent of total billed charges,81.2% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,29.6,74,,,percent of total billed charges,74% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,26.8,67,,,percent of total billed charges,67% of total billed charges,28.4,71,,,percent of total billed charges,71% of total billed charges,30.4,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,13.18,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,36,90,,,percent of total billed charges,90% of total billed charges,36,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,35.44,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,32,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,36.4,91,,,percent of total billed charges,91% of total billed charges,13.06,32.64,,,percent of total billed charges,32.64% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,13.44,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,12.8,32,,,percent of total billed charges,32% of total billed charges,12.8,32,,,percent of total billed charges,32% of total billed charges,36.8,92,,,percent of total billed charges,92% of total billed charges,12.8,36.8,
OT ELEC STIM CNSTNT/15M,3600011,CDM,430,RC,97032,HCPCS,Outpatient,,,173,147.05,,140.48,81.2,,,percent of total billed charges,81.2% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,131.48,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,57.02,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,155.7,90,,,percent of total billed charges,90% of total billed charges,155.7,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,153.28,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,157.43,91,,,percent of total billed charges,91% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,58.13,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,159.16,92,,,percent of total billed charges,92% of total billed charges,19.16,159.16,
OT IONTO EA 15 MIN,3600024,CDM,430,RC,97033,HCPCS,Outpatient,,,103,87.55,,83.64,81.2,,,percent of total billed charges,81.2% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,76.22,74,,,percent of total billed charges,74% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,69.01,67,,,percent of total billed charges,67% of total billed charges,73.13,71,,,percent of total billed charges,71% of total billed charges,78.28,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.95,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,91.26,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,82.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,93.73,91,,,percent of total billed charges,91% of total billed charges,33.62,32.64,,,percent of total billed charges,32.64% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,34.61,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,32.96,32,,,percent of total billed charges,32% of total billed charges,32.96,32,,,percent of total billed charges,32% of total billed charges,94.76,92,,,percent of total billed charges,92% of total billed charges,19.16,94.76,
OT US EA 15 MIN,3600060,CDM,430,RC,97035,HCPCS,Outpatient,,,173,147.05,,140.48,81.2,,,percent of total billed charges,81.2% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,131.48,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,57.02,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,155.7,90,,,percent of total billed charges,90% of total billed charges,155.7,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,153.28,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,157.43,91,,,percent of total billed charges,91% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,58.13,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,159.16,92,,,percent of total billed charges,92% of total billed charges,19.16,159.16,
OT EX (THERA) EA 15 MIN,3600019,CDM,430,RC,97110,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,42.56,122.36,
OT NEUROMUSC RE-ED/15M,3600039,CDM,430,RC,97112,HCPCS,Outpatient,,,135,114.75,,109.62,81.2,,,percent of total billed charges,81.2% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,102.6,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,44.5,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,119.61,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,122.85,91,,,percent of total billed charges,91% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,45.36,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,124.2,92,,,percent of total billed charges,92% of total billed charges,43.2,124.2,
OT GT TRNG EA 15 MIN,3600022,CDM,430,RC,97116,HCPCS,Outpatient,,,105,89.25,,85.26,81.2,,,percent of total billed charges,81.2% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,79.8,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,34.61,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,94.5,90,,,percent of total billed charges,90% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,93.03,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,95.55,91,,,percent of total billed charges,91% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,35.28,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,96.6,92,,,percent of total billed charges,92% of total billed charges,19.16,96.6,
OT MYOFACL REL/15M,3600038,CDM,430,RC,97140,HCPCS,Outpatient,,,135,114.75,,109.62,81.2,,,percent of total billed charges,81.2% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,102.6,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,44.5,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,119.61,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,122.85,91,,,percent of total billed charges,91% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,45.36,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,124.2,92,,,percent of total billed charges,92% of total billed charges,43.2,124.2,
OT EVAL OT LOW COMPLEXITY,3600204,CDM,434,RC,97165,HCPCS,Outpatient,,,296,251.6,,240.35,81.2,,,percent of total billed charges,81.2% of total billed charges,96.61,32.64,,,percent of total billed charges,32.64% of total billed charges,219.04,74,,,percent of total billed charges,74% of total billed charges,219.04,74,,,percent of total billed charges,74% of total billed charges,94.72,32,,,percent of total billed charges,32% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,94.72,32,,,percent of total billed charges,32% of total billed charges,210.16,71,,,percent of total billed charges,71% of total billed charges,210.16,71,,,percent of total billed charges,71% of total billed charges,198.32,67,,,percent of total billed charges,67% of total billed charges,198.32,67,,,percent of total billed charges,67% of total billed charges,210.16,71,,,percent of total billed charges,71% of total billed charges,224.96,76,,,percent of total billed charges,76% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,97.56,32.96,,,percent of total billed charges,32.96% of total billed charges,83.67,105,,,Fee Schedule,pays based on EAPG rates,266.4,90,,,percent of total billed charges,90% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,79.68,100,,,Fee Schedule,pays based on EAPG rates,262.26,88.6,,,percent of total billed charges,88.6% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,94.72,32,,,percent of total billed charges,32% of total billed charges,236.8,80,,,percent of total billed charges,80% of total billed charges,236.8,80,,,percent of total billed charges,80% of total billed charges,79.68,100,,,Fee Schedule,pays based on EAPG rates,269.36,91,,,percent of total billed charges,91% of total billed charges,96.61,32.64,,,percent of total billed charges,32.64% of total billed charges,94.72,32,,,percent of total billed charges,32% of total billed charges,99.46,33.6,,,percent of total billed charges,33.6% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,94.72,32,,,percent of total billed charges,32% of total billed charges,94.72,32,,,percent of total billed charges,32% of total billed charges,272.32,92,,,percent of total billed charges,92% of total billed charges,79.68,272.32,
OT EVAL OT MODERATE COMPLEXITY,3600203,CDM,434,RC,97166,HCPCS,Outpatient,,,303,257.55,,246.04,81.2,,,percent of total billed charges,81.2% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,230.28,76,,,percent of total billed charges,76% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,99.87,32.96,,,percent of total billed charges,32.96% of total billed charges,83.67,105,,,Fee Schedule,pays based on EAPG rates,272.7,90,,,percent of total billed charges,90% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,79.68,100,,,Fee Schedule,pays based on EAPG rates,268.46,88.6,,,percent of total billed charges,88.6% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,79.68,100,,,Fee Schedule,pays based on EAPG rates,275.73,91,,,percent of total billed charges,91% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,101.81,33.6,,,percent of total billed charges,33.6% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,278.76,92,,,percent of total billed charges,92% of total billed charges,79.68,278.76,
OT EVAL OT HIGH COMPLEXITY,3600202,CDM,434,RC,97167,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,83.67,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,79.68,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,79.68,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,79.68,284.28,
OT RE EVAL OT,3600046,CDM,434,RC,97168,HCPCS,Outpatient,,,129,109.65,,104.75,81.2,,,percent of total billed charges,81.2% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,98.04,76,,,percent of total billed charges,76% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,42.52,32.96,,,percent of total billed charges,32.96% of total billed charges,83.67,105,,,Fee Schedule,pays based on EAPG rates,116.1,90,,,percent of total billed charges,90% of total billed charges,116.1,90,,,percent of total billed charges,90% of total billed charges,79.68,100,,,Fee Schedule,pays based on EAPG rates,114.29,88.6,,,percent of total billed charges,88.6% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,79.68,100,,,Fee Schedule,pays based on EAPG rates,117.39,91,,,percent of total billed charges,91% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,43.34,33.6,,,percent of total billed charges,33.6% of total billed charges,82.08,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,118.68,92,,,percent of total billed charges,92% of total billed charges,41.28,118.68,
OT THERAPEUTIC ACT/15M,3600058,CDM,430,RC,97530,HCPCS,Outpatient,,,185,157.25,,150.22,81.2,,,percent of total billed charges,81.2% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,140.6,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,60.98,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,163.91,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,168.35,91,,,percent of total billed charges,91% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,62.16,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,170.2,92,,,percent of total billed charges,92% of total billed charges,52.41,170.2,
OT SENS INTEGR TCH/15M,3600051,CDM,430,RC,97533,HCPCS,Outpatient,,,151,128.35,,122.61,81.2,,,percent of total billed charges,81.2% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,114.76,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,49.77,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,133.79,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,137.41,91,,,percent of total billed charges,91% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,50.74,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,138.92,92,,,percent of total billed charges,92% of total billed charges,48.32,138.92,
OT ADL TRAINING EA 15 MIN,3600001,CDM,430,RC,97535,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,19.16,95.68,
OT COMM/WRK REINTIG/15M,3600007,CDM,430,RC,97537,HCPCS,Outpatient,,,160,136,,129.92,81.2,,,percent of total billed charges,81.2% of total billed charges,52.22,32.64,,,percent of total billed charges,32.64% of total billed charges,118.4,74,,,percent of total billed charges,74% of total billed charges,118.4,74,,,percent of total billed charges,74% of total billed charges,51.2,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,51.2,32,,,percent of total billed charges,32% of total billed charges,113.6,71,,,percent of total billed charges,71% of total billed charges,113.6,71,,,percent of total billed charges,71% of total billed charges,107.2,67,,,percent of total billed charges,67% of total billed charges,107.2,67,,,percent of total billed charges,67% of total billed charges,113.6,71,,,percent of total billed charges,71% of total billed charges,121.6,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,52.74,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,144,90,,,percent of total billed charges,90% of total billed charges,144,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,141.76,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,51.2,32,,,percent of total billed charges,32% of total billed charges,128,80,,,percent of total billed charges,80% of total billed charges,128,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,145.6,91,,,percent of total billed charges,91% of total billed charges,52.22,32.64,,,percent of total billed charges,32.64% of total billed charges,51.2,32,,,percent of total billed charges,32% of total billed charges,53.76,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,51.2,32,,,percent of total billed charges,32% of total billed charges,51.2,32,,,percent of total billed charges,32% of total billed charges,147.2,92,,,percent of total billed charges,92% of total billed charges,51.2,147.2,
OT WHLCHAIR MGMT/15M,3600062,CDM,430,RC,97542,HCPCS,Outpatient,,,90,76.5,,73.08,81.2,,,percent of total billed charges,81.2% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,68.4,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,29.66,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,79.74,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,81.9,91,,,percent of total billed charges,91% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,30.24,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,82.8,92,,,percent of total billed charges,92% of total billed charges,28.8,82.8,
OT WRK HRD/RCN INTL 2H,3600069,CDM,430,RC,97545,HCPCS,Outpatient,,,334,283.9,,271.21,81.2,,,percent of total billed charges,81.2% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,253.84,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,110.09,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,295.92,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,303.94,91,,,percent of total billed charges,91% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,112.22,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,307.28,92,,,percent of total billed charges,92% of total billed charges,19.16,307.28,
OT WRK HRD/RCN/ADDL HR,3600068,CDM,430,RC,97546,HCPCS,Outpatient,,,338,287.3,,274.46,81.2,,,percent of total billed charges,81.2% of total billed charges,110.32,32.64,,,percent of total billed charges,32.64% of total billed charges,250.12,74,,,percent of total billed charges,74% of total billed charges,250.12,74,,,percent of total billed charges,74% of total billed charges,108.16,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,108.16,32,,,percent of total billed charges,32% of total billed charges,239.98,71,,,percent of total billed charges,71% of total billed charges,239.98,71,,,percent of total billed charges,71% of total billed charges,226.46,67,,,percent of total billed charges,67% of total billed charges,226.46,67,,,percent of total billed charges,67% of total billed charges,239.98,71,,,percent of total billed charges,71% of total billed charges,256.88,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,111.4,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,304.2,90,,,percent of total billed charges,90% of total billed charges,304.2,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,299.47,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,108.16,32,,,percent of total billed charges,32% of total billed charges,270.4,80,,,percent of total billed charges,80% of total billed charges,270.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,307.58,91,,,percent of total billed charges,91% of total billed charges,110.32,32.64,,,percent of total billed charges,32.64% of total billed charges,108.16,32,,,percent of total billed charges,32% of total billed charges,113.57,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,108.16,32,,,percent of total billed charges,32% of total billed charges,108.16,32,,,percent of total billed charges,32% of total billed charges,310.96,92,,,percent of total billed charges,92% of total billed charges,19.16,310.96,
WOUND DEBRID,3600205,CDM,430,RC,97597,HCPCS,Outpatient,,,278,236.3,,225.74,81.2,,,percent of total billed charges,81.2% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,211.28,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,91.63,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,250.2,90,,,percent of total billed charges,90% of total billed charges,250.2,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,246.31,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,252.98,91,,,percent of total billed charges,91% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,93.41,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,255.76,92,,,percent of total billed charges,92% of total billed charges,88.96,255.76,
OT PRFRMNC TEST W/WRITTEN REPORT/15 MINS,3600021,CDM,430,RC,97750,HCPCS,Outpatient,,,117,99.45,,95,81.2,,,percent of total billed charges,81.2% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,88.92,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,38.56,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,105.3,90,,,percent of total billed charges,90% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,103.66,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,106.47,91,,,percent of total billed charges,91% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,39.31,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,107.64,92,,,percent of total billed charges,92% of total billed charges,37.44,107.64,
OT ORTHTC TRNG Q 15M INITIAL ENCOUNTER,3600041,CDM,430,RC,97760,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,31.68,91.08,
OT PRSTHTC TRNG Q 15M INITIAL ENCOUNTER,3600044,CDM,430,RC,97761,HCPCS,Outpatient,,,101,85.85,,82.01,81.2,,,percent of total billed charges,81.2% of total billed charges,32.97,32.64,,,percent of total billed charges,32.64% of total billed charges,74.74,74,,,percent of total billed charges,74% of total billed charges,74.74,74,,,percent of total billed charges,74% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,67.67,67,,,percent of total billed charges,67% of total billed charges,67.67,67,,,percent of total billed charges,67% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,76.76,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,33.29,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,89.49,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,91.91,91,,,percent of total billed charges,91% of total billed charges,32.97,32.64,,,percent of total billed charges,32.64% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,33.94,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,92.92,92,,,percent of total billed charges,92% of total billed charges,32.32,92.92,
OT BWC WRK HRD/RCN 15 MIN EA,3600201,CDM,430,RC,W0710,HCPCS,Outpatient,,,44,37.4,,35.73,81.2,,,percent of total billed charges,81.2% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,14.08,32,,,percent of total billed charges,32% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,33.44,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,14.5,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,39.6,90,,,percent of total billed charges,90% of total billed charges,39.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,38.98,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,14.08,32,,,percent of total billed charges,32% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,40.04,91,,,percent of total billed charges,91% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,14.78,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,14.08,32,,,percent of total billed charges,32% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,40.48,92,,,percent of total billed charges,92% of total billed charges,14.08,40.48,
SCF/VENI PUNCTURE,8400041,CDM,300,RC,36415,HCPCS,Outpatient,,,31,26.35,,25.17,81.2,,,percent of total billed charges,81.2% of total billed charges,10.12,32.64,,,percent of total billed charges,32.64% of total billed charges,22.94,74,,,percent of total billed charges,74% of total billed charges,22.94,74,,,percent of total billed charges,74% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,9.92,32,,,percent of total billed charges,32% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,20.77,67,,,percent of total billed charges,67% of total billed charges,20.77,67,,,percent of total billed charges,67% of total billed charges,22.01,71,,,percent of total billed charges,71% of total billed charges,23.56,76,,,percent of total billed charges,76% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,10.22,32.96,,,percent of total billed charges,32.96% of total billed charges,1.7,105,,,Fee Schedule,pays based on EAPG rates,27.9,90,,,percent of total billed charges,90% of total billed charges,27.9,90,,,percent of total billed charges,90% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,27.47,88.6,,,percent of total billed charges,88.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,9.92,32,,,percent of total billed charges,32% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,24.8,80,,,percent of total billed charges,80% of total billed charges,1.62,100,,,Fee Schedule,pays based on EAPG rates,28.21,91,,,percent of total billed charges,91% of total billed charges,10.12,32.64,,,percent of total billed charges,32.64% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,10.42,33.6,,,percent of total billed charges,33.6% of total billed charges,1.67,103,,,Fee Schedule,pays based on EAPG rates,9.92,32,,,percent of total billed charges,32% of total billed charges,9.92,32,,,percent of total billed charges,32% of total billed charges,28.52,92,,,percent of total billed charges,92% of total billed charges,1.62,28.52,
BONE MARROW BIOPSY/ASPIRATION,8400058,CDM,510,RC,38222,HCPCS,Outpatient,,,198,168.3,,160.78,81.2,,,percent of total billed charges,81.2% of total billed charges,64.63,32.64,,,percent of total billed charges,32.64% of total billed charges,146.52,74,,,percent of total billed charges,74% of total billed charges,146.52,74,,,percent of total billed charges,74% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,132.66,67,,,percent of total billed charges,67% of total billed charges,132.66,67,,,percent of total billed charges,67% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,150.48,76,,,percent of total billed charges,76% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,65.26,32.96,,,percent of total billed charges,32.96% of total billed charges,855.18,105,,,Fee Schedule,pays based on EAPG rates,178.2,90,,,percent of total billed charges,90% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,814.46,100,,,Fee Schedule,pays based on EAPG rates,175.43,88.6,,,percent of total billed charges,88.6% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,158.4,80,,,percent of total billed charges,80% of total billed charges,158.4,80,,,percent of total billed charges,80% of total billed charges,814.46,100,,,Fee Schedule,pays based on EAPG rates,180.18,91,,,percent of total billed charges,91% of total billed charges,64.63,32.64,,,percent of total billed charges,32.64% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,66.53,33.6,,,percent of total billed charges,33.6% of total billed charges,838.89,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,182.16,92,,,percent of total billed charges,92% of total billed charges,63.36,855.18,
APPLICATION ON-BODY INJECTION,8400062,CDM,280,RC,96377,HCPCS,Outpatient,,,45,38.25,,36.54,81.2,,,percent of total billed charges,81.2% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,33.3,74,,,percent of total billed charges,74% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,30.15,67,,,percent of total billed charges,67% of total billed charges,31.95,71,,,percent of total billed charges,71% of total billed charges,34.2,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,14.83,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,39.87,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,36,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,40.95,91,,,percent of total billed charges,91% of total billed charges,14.69,32.64,,,percent of total billed charges,32.64% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,15.12,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,14.4,32,,,percent of total billed charges,32% of total billed charges,14.4,32,,,percent of total billed charges,32% of total billed charges,41.4,92,,,percent of total billed charges,92% of total billed charges,14.4,41.4,
CHEMO IM/SUBQ NONHORMONAL,8400007,CDM,331,RC,96401,HCPCS,Outpatient,,,90,76.5,,73.08,81.2,,,percent of total billed charges,81.2% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,68.4,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,29.66,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,79.74,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,81.9,91,,,percent of total billed charges,91% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,30.24,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,82.8,92,,,percent of total billed charges,92% of total billed charges,28.05,82.8,
CHEMO IM/SUBQ INJ HORMONAL,8400048,CDM,331,RC,96402,HCPCS,Outpatient,,,89,75.65,,72.27,81.2,,,percent of total billed charges,81.2% of total billed charges,29.05,32.64,,,percent of total billed charges,32.64% of total billed charges,65.86,74,,,percent of total billed charges,74% of total billed charges,65.86,74,,,percent of total billed charges,74% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,59.63,67,,,percent of total billed charges,67% of total billed charges,59.63,67,,,percent of total billed charges,67% of total billed charges,63.19,71,,,percent of total billed charges,71% of total billed charges,67.64,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,29.33,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,80.1,90,,,percent of total billed charges,90% of total billed charges,80.1,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,78.85,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,71.2,80,,,percent of total billed charges,80% of total billed charges,71.2,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,80.99,91,,,percent of total billed charges,91% of total billed charges,29.05,32.64,,,percent of total billed charges,32.64% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,29.9,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,28.48,32,,,percent of total billed charges,32% of total billed charges,28.48,32,,,percent of total billed charges,32% of total billed charges,81.88,92,,,percent of total billed charges,92% of total billed charges,28.05,81.88,
CHEMO INTRAVENOUS PUSH SINGLE,8400003,CDM,331,RC,96409,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,28.05,95.68,
CHEMO IV PUSH EA ADDITIONAL,8400049,CDM,331,RC,96411,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,28.05,95.68,
CHEMO/HIGH COMPLX IV INFUSION UP TO 1 HR,8400004,CDM,335,RC,96413,HCPCS,Outpatient,,,1041,884.85,,845.29,81.2,,,percent of total billed charges,81.2% of total billed charges,339.78,32.64,,,percent of total billed charges,32.64% of total billed charges,770.34,74,,,percent of total billed charges,74% of total billed charges,770.34,74,,,percent of total billed charges,74% of total billed charges,333.12,32,,,percent of total billed charges,32% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,333.12,32,,,percent of total billed charges,32% of total billed charges,739.11,71,,,percent of total billed charges,71% of total billed charges,739.11,71,,,percent of total billed charges,71% of total billed charges,697.47,67,,,percent of total billed charges,67% of total billed charges,697.47,67,,,percent of total billed charges,67% of total billed charges,739.11,71,,,percent of total billed charges,71% of total billed charges,791.16,76,,,percent of total billed charges,76% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,343.11,32.96,,,percent of total billed charges,32.96% of total billed charges,179.54,105,,,Fee Schedule,pays based on EAPG rates,936.9,90,,,percent of total billed charges,90% of total billed charges,936.9,90,,,percent of total billed charges,90% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,922.33,88.6,,,percent of total billed charges,88.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,333.12,32,,,percent of total billed charges,32% of total billed charges,832.8,80,,,percent of total billed charges,80% of total billed charges,832.8,80,,,percent of total billed charges,80% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,947.31,91,,,percent of total billed charges,91% of total billed charges,339.78,32.64,,,percent of total billed charges,32.64% of total billed charges,333.12,32,,,percent of total billed charges,32% of total billed charges,349.78,33.6,,,percent of total billed charges,33.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,333.12,32,,,percent of total billed charges,32% of total billed charges,333.12,32,,,percent of total billed charges,32% of total billed charges,957.72,92,,,percent of total billed charges,92% of total billed charges,170.99,957.72,
CHEMO/HIGH COMPLX IV INFUSION EA ADDL HR,8400005,CDM,335,RC,96415,HCPCS,Outpatient,,,151,128.35,,122.61,81.2,,,percent of total billed charges,81.2% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,111.74,74,,,percent of total billed charges,74% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,101.17,67,,,percent of total billed charges,67% of total billed charges,107.21,71,,,percent of total billed charges,71% of total billed charges,114.76,76,,,percent of total billed charges,76% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,49.77,32.96,,,percent of total billed charges,32.96% of total billed charges,252.92,105,,,Fee Schedule,pays based on EAPG rates,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,240.87,100,,,Fee Schedule,pays based on EAPG rates,133.79,88.6,,,percent of total billed charges,88.6% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,120.8,80,,,percent of total billed charges,80% of total billed charges,240.87,100,,,Fee Schedule,pays based on EAPG rates,137.41,91,,,percent of total billed charges,91% of total billed charges,49.29,32.64,,,percent of total billed charges,32.64% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,50.74,33.6,,,percent of total billed charges,33.6% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,48.32,32,,,percent of total billed charges,32% of total billed charges,48.32,32,,,percent of total billed charges,32% of total billed charges,138.92,92,,,percent of total billed charges,92% of total billed charges,48.32,252.92,
CHEMO IV INF> 8 HRS W/ PUMP,8400006,CDM,335,RC,96416,HCPCS,Outpatient,,,1055,896.75,,856.66,81.2,,,percent of total billed charges,81.2% of total billed charges,344.35,32.64,,,percent of total billed charges,32.64% of total billed charges,780.7,74,,,percent of total billed charges,74% of total billed charges,780.7,74,,,percent of total billed charges,74% of total billed charges,337.6,32,,,percent of total billed charges,32% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,337.6,32,,,percent of total billed charges,32% of total billed charges,749.05,71,,,percent of total billed charges,71% of total billed charges,749.05,71,,,percent of total billed charges,71% of total billed charges,706.85,67,,,percent of total billed charges,67% of total billed charges,706.85,67,,,percent of total billed charges,67% of total billed charges,749.05,71,,,percent of total billed charges,71% of total billed charges,801.8,76,,,percent of total billed charges,76% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,347.73,32.96,,,percent of total billed charges,32.96% of total billed charges,252.92,105,,,Fee Schedule,pays based on EAPG rates,949.5,90,,,percent of total billed charges,90% of total billed charges,949.5,90,,,percent of total billed charges,90% of total billed charges,240.87,100,,,Fee Schedule,pays based on EAPG rates,934.73,88.6,,,percent of total billed charges,88.6% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,337.6,32,,,percent of total billed charges,32% of total billed charges,844,80,,,percent of total billed charges,80% of total billed charges,844,80,,,percent of total billed charges,80% of total billed charges,240.87,100,,,Fee Schedule,pays based on EAPG rates,960.05,91,,,percent of total billed charges,91% of total billed charges,344.35,32.64,,,percent of total billed charges,32.64% of total billed charges,337.6,32,,,percent of total billed charges,32% of total billed charges,354.48,33.6,,,percent of total billed charges,33.6% of total billed charges,248.1,103,,,Fee Schedule,pays based on EAPG rates,337.6,32,,,percent of total billed charges,32% of total billed charges,337.6,32,,,percent of total billed charges,32% of total billed charges,970.6,92,,,percent of total billed charges,92% of total billed charges,240.87,970.6,
CHEMO IV INF UP TO 1 HR DIFFERENT,8400053,CDM,335,RC,96417,HCPCS,Outpatient,,,174,147.9,,141.29,81.2,,,percent of total billed charges,81.2% of total billed charges,56.79,32.64,,,percent of total billed charges,32.64% of total billed charges,128.76,74,,,percent of total billed charges,74% of total billed charges,128.76,74,,,percent of total billed charges,74% of total billed charges,55.68,32,,,percent of total billed charges,32% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,55.68,32,,,percent of total billed charges,32% of total billed charges,123.54,71,,,percent of total billed charges,71% of total billed charges,123.54,71,,,percent of total billed charges,71% of total billed charges,116.58,67,,,percent of total billed charges,67% of total billed charges,116.58,67,,,percent of total billed charges,67% of total billed charges,123.54,71,,,percent of total billed charges,71% of total billed charges,132.24,76,,,percent of total billed charges,76% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,57.35,32.96,,,percent of total billed charges,32.96% of total billed charges,179.54,105,,,Fee Schedule,pays based on EAPG rates,156.6,90,,,percent of total billed charges,90% of total billed charges,156.6,90,,,percent of total billed charges,90% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,154.16,88.6,,,percent of total billed charges,88.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,55.68,32,,,percent of total billed charges,32% of total billed charges,139.2,80,,,percent of total billed charges,80% of total billed charges,139.2,80,,,percent of total billed charges,80% of total billed charges,170.99,100,,,Fee Schedule,pays based on EAPG rates,158.34,91,,,percent of total billed charges,91% of total billed charges,56.79,32.64,,,percent of total billed charges,32.64% of total billed charges,55.68,32,,,percent of total billed charges,32% of total billed charges,58.46,33.6,,,percent of total billed charges,33.6% of total billed charges,176.12,103,,,Fee Schedule,pays based on EAPG rates,55.68,32,,,percent of total billed charges,32% of total billed charges,55.68,32,,,percent of total billed charges,32% of total billed charges,160.08,92,,,percent of total billed charges,92% of total billed charges,55.68,179.54,
ADMIN REFILL CHEMO INFUSION PUMP,8400064,CDM,761,RC,96521,HCPCS,Outpatient,,,655,556.75,,531.86,81.2,,,percent of total billed charges,81.2% of total billed charges,213.79,32.64,,,percent of total billed charges,32.64% of total billed charges,484.7,74,,,percent of total billed charges,74% of total billed charges,484.7,74,,,percent of total billed charges,74% of total billed charges,209.6,32,,,percent of total billed charges,32% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,209.6,32,,,percent of total billed charges,32% of total billed charges,465.05,71,,,percent of total billed charges,71% of total billed charges,465.05,71,,,percent of total billed charges,71% of total billed charges,438.85,67,,,percent of total billed charges,67% of total billed charges,438.85,67,,,percent of total billed charges,67% of total billed charges,465.05,71,,,percent of total billed charges,71% of total billed charges,497.8,76,,,percent of total billed charges,76% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,215.89,32.96,,,percent of total billed charges,32.96% of total billed charges,29.46,105,,,Fee Schedule,pays based on EAPG rates,589.5,90,,,percent of total billed charges,90% of total billed charges,589.5,90,,,percent of total billed charges,90% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,580.33,88.6,,,percent of total billed charges,88.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,209.6,32,,,percent of total billed charges,32% of total billed charges,524,80,,,percent of total billed charges,80% of total billed charges,524,80,,,percent of total billed charges,80% of total billed charges,28.05,100,,,Fee Schedule,pays based on EAPG rates,596.05,91,,,percent of total billed charges,91% of total billed charges,213.79,32.64,,,percent of total billed charges,32.64% of total billed charges,209.6,32,,,percent of total billed charges,32% of total billed charges,220.08,33.6,,,percent of total billed charges,33.6% of total billed charges,28.89,103,,,Fee Schedule,pays based on EAPG rates,209.6,32,,,percent of total billed charges,32% of total billed charges,209.6,32,,,percent of total billed charges,32% of total billed charges,602.6,92,,,percent of total billed charges,92% of total billed charges,28.05,602.6,
LEVEL 2 VISIT NEW PATIENT,8400022,CDM,510,RC,99202,HCPCS,Outpatient,,,187,158.95,,151.84,81.2,,,percent of total billed charges,81.2% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,142.12,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,61.64,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,168.3,90,,,percent of total billed charges,90% of total billed charges,168.3,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,165.68,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,170.17,91,,,percent of total billed charges,91% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,62.83,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,172.04,92,,,percent of total billed charges,92% of total billed charges,42.34,172.04,
LEVEL 3 VISIT NEW PATIENT,8400023,CDM,510,RC,99203,HCPCS,Outpatient,,,281,238.85,,228.17,81.2,,,percent of total billed charges,81.2% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,213.56,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,92.62,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,252.9,90,,,percent of total billed charges,90% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,248.97,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,255.71,91,,,percent of total billed charges,91% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,94.42,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,258.52,92,,,percent of total billed charges,92% of total billed charges,42.34,258.52,
LEVEL 4 VISIT NEW PATIENT,8400024,CDM,510,RC,99204,HCPCS,Outpatient,,,347,294.95,,281.76,81.2,,,percent of total billed charges,81.2% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,263.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,114.37,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,312.3,90,,,percent of total billed charges,90% of total billed charges,312.3,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,307.44,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,315.77,91,,,percent of total billed charges,91% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,116.59,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,319.24,92,,,percent of total billed charges,92% of total billed charges,42.34,319.24,
LEVEL 5 VISIT NEW PATIENT,8400025,CDM,510,RC,99205,HCPCS,Outpatient,,,371,315.35,,301.25,81.2,,,percent of total billed charges,81.2% of total billed charges,121.09,32.64,,,percent of total billed charges,32.64% of total billed charges,274.54,74,,,percent of total billed charges,74% of total billed charges,274.54,74,,,percent of total billed charges,74% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,248.57,67,,,percent of total billed charges,67% of total billed charges,248.57,67,,,percent of total billed charges,67% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,281.96,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,122.28,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,333.9,90,,,percent of total billed charges,90% of total billed charges,333.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,328.71,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,296.8,80,,,percent of total billed charges,80% of total billed charges,296.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,337.61,91,,,percent of total billed charges,91% of total billed charges,121.09,32.64,,,percent of total billed charges,32.64% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,124.66,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,341.32,92,,,percent of total billed charges,92% of total billed charges,42.34,341.32,
LEVEL 1 VISIT EST PATIENT,8400026,CDM,510,RC,99211,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,39.04,112.24,
LEVEL 2 VISIT EST PATIENT,8400027,CDM,510,RC,99212,HCPCS,Outpatient,,,168,142.8,,136.42,81.2,,,percent of total billed charges,81.2% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,127.68,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,55.37,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,148.85,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,152.88,91,,,percent of total billed charges,91% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,56.45,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,154.56,92,,,percent of total billed charges,92% of total billed charges,42.34,154.56,
LEVEL 3 VISIT EST PATIENT,8400028,CDM,510,RC,99213,HCPCS,Outpatient,,,248,210.8,,201.38,81.2,,,percent of total billed charges,81.2% of total billed charges,80.95,32.64,,,percent of total billed charges,32.64% of total billed charges,183.52,74,,,percent of total billed charges,74% of total billed charges,183.52,74,,,percent of total billed charges,74% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,166.16,67,,,percent of total billed charges,67% of total billed charges,166.16,67,,,percent of total billed charges,67% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,188.48,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,81.74,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,223.2,90,,,percent of total billed charges,90% of total billed charges,223.2,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,219.73,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,225.68,91,,,percent of total billed charges,91% of total billed charges,80.95,32.64,,,percent of total billed charges,32.64% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,83.33,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,228.16,92,,,percent of total billed charges,92% of total billed charges,42.34,228.16,
LEVEL 4 VISIT EST PATIENT,8400029,CDM,510,RC,99214,HCPCS,Outpatient,,,291,247.35,,236.29,81.2,,,percent of total billed charges,81.2% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,221.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,95.91,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,261.9,90,,,percent of total billed charges,90% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,257.83,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,264.81,91,,,percent of total billed charges,91% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,97.78,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,267.72,92,,,percent of total billed charges,92% of total billed charges,42.34,267.72,
LEVEL 5 VISIT EST PATIENT,8400030,CDM,510,RC,99215,HCPCS,Outpatient,,,341,289.85,,276.89,81.2,,,percent of total billed charges,81.2% of total billed charges,111.3,32.64,,,percent of total billed charges,32.64% of total billed charges,252.34,74,,,percent of total billed charges,74% of total billed charges,252.34,74,,,percent of total billed charges,74% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,228.47,67,,,percent of total billed charges,67% of total billed charges,228.47,67,,,percent of total billed charges,67% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,259.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,112.39,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,306.9,90,,,percent of total billed charges,90% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,302.13,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,272.8,80,,,percent of total billed charges,80% of total billed charges,272.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,310.31,91,,,percent of total billed charges,91% of total billed charges,111.3,32.64,,,percent of total billed charges,32.64% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,114.58,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,313.72,92,,,percent of total billed charges,92% of total billed charges,42.34,313.72,
COUNSELING VISIT LUNG CANCER DISCUSSION,8400063,CDM,510,RC,G0296,HCPCS,Outpatient,,,241,204.85,,195.69,81.2,,,percent of total billed charges,81.2% of total billed charges,78.66,32.64,,,percent of total billed charges,32.64% of total billed charges,178.34,74,,,percent of total billed charges,74% of total billed charges,178.34,74,,,percent of total billed charges,74% of total billed charges,77.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,171.11,71,,,percent of total billed charges,71% of total billed charges,171.11,71,,,percent of total billed charges,71% of total billed charges,161.47,67,,,percent of total billed charges,67% of total billed charges,161.47,67,,,percent of total billed charges,67% of total billed charges,171.11,71,,,percent of total billed charges,71% of total billed charges,183.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.43,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,213.53,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,192.8,80,,,percent of total billed charges,80% of total billed charges,192.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,219.31,91,,,percent of total billed charges,91% of total billed charges,78.66,32.64,,,percent of total billed charges,32.64% of total billed charges,77.12,32,,,percent of total billed charges,32% of total billed charges,80.98,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,77.12,32,,,percent of total billed charges,32% of total billed charges,77.12,32,,,percent of total billed charges,32% of total billed charges,221.72,92,,,percent of total billed charges,92% of total billed charges,42.34,221.72,
FOLEY CATH INSERTION,8000127,CDM,761,RC,51702,HCPCS,Outpatient,,,79,67.15,,64.15,81.2,,,percent of total billed charges,81.2% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,58.46,74,,,percent of total billed charges,74% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,52.93,67,,,percent of total billed charges,67% of total billed charges,56.09,71,,,percent of total billed charges,71% of total billed charges,60.04,76,,,percent of total billed charges,76% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,26.04,32.96,,,percent of total billed charges,32.96% of total billed charges,32.13,105,,,Fee Schedule,pays based on EAPG rates,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,69.99,88.6,,,percent of total billed charges,88.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,63.2,80,,,percent of total billed charges,80% of total billed charges,30.6,100,,,Fee Schedule,pays based on EAPG rates,71.89,91,,,percent of total billed charges,91% of total billed charges,25.79,32.64,,,percent of total billed charges,32.64% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,26.54,33.6,,,percent of total billed charges,33.6% of total billed charges,31.52,103,,,Fee Schedule,pays based on EAPG rates,25.28,32,,,percent of total billed charges,32% of total billed charges,25.28,32,,,percent of total billed charges,32% of total billed charges,72.68,92,,,percent of total billed charges,92% of total billed charges,25.28,72.68,
LEVEL 2 VISIT NEW PATIENT,8000052,CDM,510,RC,99202,HCPCS,Outpatient,,,187,158.95,,151.84,81.2,,,percent of total billed charges,81.2% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,142.12,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,61.64,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,168.3,90,,,percent of total billed charges,90% of total billed charges,168.3,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,165.68,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,170.17,91,,,percent of total billed charges,91% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,62.83,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,172.04,92,,,percent of total billed charges,92% of total billed charges,42.34,172.04,
LEVEL 3 VISIT NEW PATIENT,8000053,CDM,510,RC,99203,HCPCS,Outpatient,,,281,238.85,,228.17,81.2,,,percent of total billed charges,81.2% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,213.56,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,92.62,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,252.9,90,,,percent of total billed charges,90% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,248.97,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,255.71,91,,,percent of total billed charges,91% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,94.42,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,258.52,92,,,percent of total billed charges,92% of total billed charges,42.34,258.52,
LEVEL 4 VISIT NEW PATIENT,8000054,CDM,510,RC,99204,HCPCS,Outpatient,,,347,294.95,,281.76,81.2,,,percent of total billed charges,81.2% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,263.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,114.37,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,312.3,90,,,percent of total billed charges,90% of total billed charges,312.3,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,307.44,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,315.77,91,,,percent of total billed charges,91% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,116.59,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,319.24,92,,,percent of total billed charges,92% of total billed charges,42.34,319.24,
LEVEL 5 VISIT NEW PATIENT,8000055,CDM,510,RC,99205,HCPCS,Outpatient,,,371,315.35,,301.25,81.2,,,percent of total billed charges,81.2% of total billed charges,121.09,32.64,,,percent of total billed charges,32.64% of total billed charges,274.54,74,,,percent of total billed charges,74% of total billed charges,274.54,74,,,percent of total billed charges,74% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,248.57,67,,,percent of total billed charges,67% of total billed charges,248.57,67,,,percent of total billed charges,67% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,281.96,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,122.28,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,333.9,90,,,percent of total billed charges,90% of total billed charges,333.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,328.71,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,296.8,80,,,percent of total billed charges,80% of total billed charges,296.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,337.61,91,,,percent of total billed charges,91% of total billed charges,121.09,32.64,,,percent of total billed charges,32.64% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,124.66,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,341.32,92,,,percent of total billed charges,92% of total billed charges,42.34,341.32,
CLINIC TREATMENT ROOM,8000047,CDM,761,RC,99211,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,39.04,112.24,
LEVEL 1 VISIT EST PATIENT,8000056,CDM,510,RC,99211,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,39.04,112.24,
LEVEL 2 VISIT EST PATIENT,8000057,CDM,510,RC,99212,HCPCS,Outpatient,,,168,142.8,,136.42,81.2,,,percent of total billed charges,81.2% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,127.68,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,55.37,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,148.85,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,152.88,91,,,percent of total billed charges,91% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,56.45,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,154.56,92,,,percent of total billed charges,92% of total billed charges,42.34,154.56,
LEVEL 3 VISIT EST PATIENT,8000058,CDM,510,RC,99213,HCPCS,Outpatient,,,248,210.8,,201.38,81.2,,,percent of total billed charges,81.2% of total billed charges,80.95,32.64,,,percent of total billed charges,32.64% of total billed charges,183.52,74,,,percent of total billed charges,74% of total billed charges,183.52,74,,,percent of total billed charges,74% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,166.16,67,,,percent of total billed charges,67% of total billed charges,166.16,67,,,percent of total billed charges,67% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,188.48,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,81.74,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,223.2,90,,,percent of total billed charges,90% of total billed charges,223.2,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,219.73,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,225.68,91,,,percent of total billed charges,91% of total billed charges,80.95,32.64,,,percent of total billed charges,32.64% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,83.33,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,228.16,92,,,percent of total billed charges,92% of total billed charges,42.34,228.16,
LEVEL 4 VISIT EST PATIENT,8000059,CDM,510,RC,99214,HCPCS,Outpatient,,,291,247.35,,236.29,81.2,,,percent of total billed charges,81.2% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,221.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,95.91,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,261.9,90,,,percent of total billed charges,90% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,257.83,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,264.81,91,,,percent of total billed charges,91% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,97.78,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,267.72,92,,,percent of total billed charges,92% of total billed charges,42.34,267.72,
LEVEL 5 VISIT EST PATIENT,8000060,CDM,510,RC,99215,HCPCS,Outpatient,,,341,289.85,,276.89,81.2,,,percent of total billed charges,81.2% of total billed charges,111.3,32.64,,,percent of total billed charges,32.64% of total billed charges,252.34,74,,,percent of total billed charges,74% of total billed charges,252.34,74,,,percent of total billed charges,74% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,228.47,67,,,percent of total billed charges,67% of total billed charges,228.47,67,,,percent of total billed charges,67% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,259.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,112.39,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,306.9,90,,,percent of total billed charges,90% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,302.13,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,272.8,80,,,percent of total billed charges,80% of total billed charges,272.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,310.31,91,,,percent of total billed charges,91% of total billed charges,111.3,32.64,,,percent of total billed charges,32.64% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,114.58,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,313.72,92,,,percent of total billed charges,92% of total billed charges,42.34,313.72,
PSYCH DIAGNOSTIC EVAL (W/O MED),7200000,CDM,900,RC,90791,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,109.79,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,109.79,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,111.93,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,106.6,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,109.79,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,106.6,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,109.79,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,106.6,396.52,
PSYCH DIAGNOSTIC EVAL (W/ MED),7200001,CDM,900,RC,90792,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,109.79,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,109.79,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,111.93,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,106.6,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,109.79,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,106.6,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,109.79,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,106.6,396.52,
INDIVIDUAL THERAPY 16-37 MIN,7200003,CDM,914,RC,90832,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,52.91,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,52.91,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,53.94,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,51.37,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,52.91,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,51.37,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,52.91,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,51.37,396.52,
INDIVIDUAL THERAPY 38-52 MIN,7200004,CDM,914,RC,90834,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,67.48,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,64.26,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,64.26,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,64.26,396.52,
INDIVIDUAL THERAPY 53-67 MIN,7200005,CDM,914,RC,90837,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,67.48,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,64.26,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,64.26,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,64.26,396.52,
"PSYCHOTHERAPY FOR CRISIS, FIRST 60 MIN",7200006,CDM,914,RC,90839,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,67.48,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,64.26,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,64.26,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,66.19,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,64.26,396.52,
FAMILY THERAPY W/O PATIENT,7200007,CDM,916,RC,90846,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,88.35,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,88.35,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,90.07,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,85.78,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,88.35,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,85.78,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,88.35,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,85.78,396.52,
FAMILY THERAPY W/ PATIENT,7200008,CDM,916,RC,90847,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,88.35,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,88.35,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,90.07,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,85.78,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,88.35,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,85.78,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,88.35,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,85.78,396.52,
GROUP THERAPY,7200002,CDM,915,RC,90853,HCPCS,Outpatient,,,258,219.3,,209.5,81.2,,,percent of total billed charges,81.2% of total billed charges,84.21,32.64,,,percent of total billed charges,32.64% of total billed charges,190.92,74,,,percent of total billed charges,74% of total billed charges,190.92,74,,,percent of total billed charges,74% of total billed charges,82.56,32,,,percent of total billed charges,32% of total billed charges,73.3,103,,,Fee Schedule,pays based on EAPG rates,82.56,32,,,percent of total billed charges,32% of total billed charges,183.18,71,,,percent of total billed charges,71% of total billed charges,183.18,71,,,percent of total billed charges,71% of total billed charges,172.86,67,,,percent of total billed charges,67% of total billed charges,172.86,67,,,percent of total billed charges,67% of total billed charges,183.18,71,,,percent of total billed charges,71% of total billed charges,196.08,76,,,percent of total billed charges,76% of total billed charges,73.3,103,,,Fee Schedule,pays based on EAPG rates,85.04,32.96,,,percent of total billed charges,32.96% of total billed charges,74.73,105,,,Fee Schedule,pays based on EAPG rates,232.2,90,,,percent of total billed charges,90% of total billed charges,232.2,90,,,percent of total billed charges,90% of total billed charges,71.17,100,,,Fee Schedule,pays based on EAPG rates,228.59,88.6,,,percent of total billed charges,88.6% of total billed charges,73.3,103,,,Fee Schedule,pays based on EAPG rates,82.56,32,,,percent of total billed charges,32% of total billed charges,206.4,80,,,percent of total billed charges,80% of total billed charges,206.4,80,,,percent of total billed charges,80% of total billed charges,71.17,100,,,Fee Schedule,pays based on EAPG rates,234.78,91,,,percent of total billed charges,91% of total billed charges,84.21,32.64,,,percent of total billed charges,32.64% of total billed charges,82.56,32,,,percent of total billed charges,32% of total billed charges,86.69,33.6,,,percent of total billed charges,33.6% of total billed charges,73.3,103,,,Fee Schedule,pays based on EAPG rates,82.56,32,,,percent of total billed charges,32% of total billed charges,82.56,32,,,percent of total billed charges,32% of total billed charges,237.36,92,,,percent of total billed charges,92% of total billed charges,71.17,237.36,
OUTPATIENT CLINIC VISIT (MCR),7200009,CDM,510,RC,G0463,HCPCS,Outpatient,,,380,323,,308.56,81.2,,,percent of total billed charges,81.2% of total billed charges,124.03,32.64,,,percent of total billed charges,32.64% of total billed charges,281.2,74,,,percent of total billed charges,74% of total billed charges,281.2,74,,,percent of total billed charges,74% of total billed charges,121.6,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,121.6,32,,,percent of total billed charges,32% of total billed charges,269.8,71,,,percent of total billed charges,71% of total billed charges,269.8,71,,,percent of total billed charges,71% of total billed charges,254.6,67,,,percent of total billed charges,67% of total billed charges,254.6,67,,,percent of total billed charges,67% of total billed charges,269.8,71,,,percent of total billed charges,71% of total billed charges,288.8,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,125.25,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,342,90,,,percent of total billed charges,90% of total billed charges,342,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,336.68,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,121.6,32,,,percent of total billed charges,32% of total billed charges,304,80,,,percent of total billed charges,80% of total billed charges,304,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,345.8,91,,,percent of total billed charges,91% of total billed charges,124.03,32.64,,,percent of total billed charges,32.64% of total billed charges,121.6,32,,,percent of total billed charges,32% of total billed charges,127.68,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,121.6,32,,,percent of total billed charges,32% of total billed charges,121.6,32,,,percent of total billed charges,32% of total billed charges,349.6,92,,,percent of total billed charges,92% of total billed charges,42.34,349.6,
INJ TENDON SHEATH/LIGAMENT-PC,7901001,CDM,511,RC,20550,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,107.66,657.8,
TRIGGER POINT INJ-1 OR 2 MUSCL,7901003,CDM,511,RC,20552,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,107.66,657.8,
TRIGGER POINT INJ-3 OR MORE MUSCL,7901004,CDM,511,RC,20553,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,107.66,657.8,
INJECTION BURSA/JOINT SMALL-PC,7901005,CDM,511,RC,20600,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,107.66,657.8,
INJECTION BURSA/JOINT SM W/US GUIDE-PC,7901114,CDM,511,RC,20604,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,204.75,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,195,657.8,
INJECTION BURSA/JOINT MED-PC,7901006,CDM,511,RC,20605,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,107.66,657.8,
INJECTION BURSA/JOINT MED W/US GUIDE-PC,7901009,CDM,511,RC,20606,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,204.75,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,195,657.8,
INJECTION BURSA/JOINT LG,7901007,CDM,511,RC,20610,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,107.66,657.8,
INJECTION BURSA/JOINT LARGE-PC,7901008,CDM,511,RC,20611,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,204.75,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,195,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,200.85,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,195,657.8,
INJ ANESTH; GREATER OCCIPITAL NERVE,7901038,CDM,360,RC,64405,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,178.23,657.8,
NB FEMORAL,7901051,CDM,511,RC,64447,HCPCS,Outpatient,,,1870,1589.5,,1518.44,81.2,,,percent of total billed charges,81.2% of total billed charges,610.37,32.64,,,percent of total billed charges,32.64% of total billed charges,1383.8,74,,,percent of total billed charges,74% of total billed charges,1383.8,74,,,percent of total billed charges,74% of total billed charges,598.4,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,598.4,32,,,percent of total billed charges,32% of total billed charges,1327.7,71,,,percent of total billed charges,71% of total billed charges,1327.7,71,,,percent of total billed charges,71% of total billed charges,1252.9,67,,,percent of total billed charges,67% of total billed charges,1252.9,67,,,percent of total billed charges,67% of total billed charges,1327.7,71,,,percent of total billed charges,71% of total billed charges,1421.2,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,616.35,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,1683,90,,,percent of total billed charges,90% of total billed charges,1683,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1656.82,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,598.4,32,,,percent of total billed charges,32% of total billed charges,1496,80,,,percent of total billed charges,80% of total billed charges,1496,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,1701.7,91,,,percent of total billed charges,91% of total billed charges,610.37,32.64,,,percent of total billed charges,32.64% of total billed charges,598.4,32,,,percent of total billed charges,32% of total billed charges,628.32,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,598.4,32,,,percent of total billed charges,32% of total billed charges,598.4,32,,,percent of total billed charges,32% of total billed charges,1720.4,92,,,percent of total billed charges,92% of total billed charges,178.23,1720.4,
NB OTHER PERIPHERAL,7901052,CDM,360,RC,64450,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,178.23,657.8,
CHEMODENERVATION MUSCLE MIGRAINE,7901070,CDM,511,RC,64615,HCPCS,Outpatient,,,715,607.75,,580.58,81.2,,,percent of total billed charges,81.2% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,529.1,74,,,percent of total billed charges,74% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,479.05,67,,,percent of total billed charges,67% of total billed charges,507.65,71,,,percent of total billed charges,71% of total billed charges,543.4,76,,,percent of total billed charges,76% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,235.66,32.96,,,percent of total billed charges,32.96% of total billed charges,187.15,105,,,Fee Schedule,pays based on EAPG rates,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,633.49,88.6,,,percent of total billed charges,88.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,572,80,,,percent of total billed charges,80% of total billed charges,178.23,100,,,Fee Schedule,pays based on EAPG rates,650.65,91,,,percent of total billed charges,91% of total billed charges,233.38,32.64,,,percent of total billed charges,32.64% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,240.24,33.6,,,percent of total billed charges,33.6% of total billed charges,183.58,103,,,Fee Schedule,pays based on EAPG rates,228.8,32,,,percent of total billed charges,32% of total billed charges,228.8,32,,,percent of total billed charges,32% of total billed charges,657.8,92,,,percent of total billed charges,92% of total billed charges,178.23,657.8,
LEVEL 2 VISIT NEW PATIENT,7901098,CDM,511,RC,99202,HCPCS,Outpatient,,,187,158.95,,151.84,81.2,,,percent of total billed charges,81.2% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,142.12,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,61.64,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,168.3,90,,,percent of total billed charges,90% of total billed charges,168.3,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,165.68,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,170.17,91,,,percent of total billed charges,91% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,62.83,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,172.04,92,,,percent of total billed charges,92% of total billed charges,42.34,172.04,
LEVEL 3 VISIT NEW PATIENT,7901099,CDM,511,RC,99203,HCPCS,Outpatient,,,281,238.85,,228.17,81.2,,,percent of total billed charges,81.2% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,213.56,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,92.62,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,252.9,90,,,percent of total billed charges,90% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,248.97,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,255.71,91,,,percent of total billed charges,91% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,94.42,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,258.52,92,,,percent of total billed charges,92% of total billed charges,42.34,258.52,
LEVEL 4 VISIT NEW PATIENT,7901100,CDM,511,RC,99204,HCPCS,Outpatient,,,347,294.95,,281.76,81.2,,,percent of total billed charges,81.2% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,256.78,74,,,percent of total billed charges,74% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,232.49,67,,,percent of total billed charges,67% of total billed charges,246.37,71,,,percent of total billed charges,71% of total billed charges,263.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,114.37,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,312.3,90,,,percent of total billed charges,90% of total billed charges,312.3,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,307.44,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,277.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,315.77,91,,,percent of total billed charges,91% of total billed charges,113.26,32.64,,,percent of total billed charges,32.64% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,116.59,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,111.04,32,,,percent of total billed charges,32% of total billed charges,111.04,32,,,percent of total billed charges,32% of total billed charges,319.24,92,,,percent of total billed charges,92% of total billed charges,42.34,319.24,
LEVEL 5 VISIT NEW PATIENT,7901101,CDM,511,RC,99205,HCPCS,Outpatient,,,371,315.35,,301.25,81.2,,,percent of total billed charges,81.2% of total billed charges,121.09,32.64,,,percent of total billed charges,32.64% of total billed charges,274.54,74,,,percent of total billed charges,74% of total billed charges,274.54,74,,,percent of total billed charges,74% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,248.57,67,,,percent of total billed charges,67% of total billed charges,248.57,67,,,percent of total billed charges,67% of total billed charges,263.41,71,,,percent of total billed charges,71% of total billed charges,281.96,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,122.28,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,333.9,90,,,percent of total billed charges,90% of total billed charges,333.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,328.71,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,296.8,80,,,percent of total billed charges,80% of total billed charges,296.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,337.61,91,,,percent of total billed charges,91% of total billed charges,121.09,32.64,,,percent of total billed charges,32.64% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,124.66,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,118.72,32,,,percent of total billed charges,32% of total billed charges,118.72,32,,,percent of total billed charges,32% of total billed charges,341.32,92,,,percent of total billed charges,92% of total billed charges,42.34,341.32,
LEVEL 1 VISIT EST PATIENT,7901102,CDM,511,RC,99211,HCPCS,Outpatient,,,122,103.7,,99.06,81.2,,,percent of total billed charges,81.2% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,90.28,74,,,percent of total billed charges,74% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,81.74,67,,,percent of total billed charges,67% of total billed charges,86.62,71,,,percent of total billed charges,71% of total billed charges,92.72,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,40.21,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,109.8,90,,,percent of total billed charges,90% of total billed charges,109.8,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,108.09,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,97.6,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,111.02,91,,,percent of total billed charges,91% of total billed charges,39.82,32.64,,,percent of total billed charges,32.64% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,40.99,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,39.04,32,,,percent of total billed charges,32% of total billed charges,39.04,32,,,percent of total billed charges,32% of total billed charges,112.24,92,,,percent of total billed charges,92% of total billed charges,39.04,112.24,
LEVEL 2 VISIT EST PT,7901103,CDM,511,RC,99212,HCPCS,Outpatient,,,168,142.8,,136.42,81.2,,,percent of total billed charges,81.2% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,124.32,74,,,percent of total billed charges,74% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,112.56,67,,,percent of total billed charges,67% of total billed charges,119.28,71,,,percent of total billed charges,71% of total billed charges,127.68,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,55.37,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,148.85,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,134.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,152.88,91,,,percent of total billed charges,91% of total billed charges,54.84,32.64,,,percent of total billed charges,32.64% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,56.45,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,53.76,32,,,percent of total billed charges,32% of total billed charges,53.76,32,,,percent of total billed charges,32% of total billed charges,154.56,92,,,percent of total billed charges,92% of total billed charges,42.34,154.56,
LEVEL 3 VISIT EST PATIENT,7901104,CDM,511,RC,99213,HCPCS,Outpatient,,,248,210.8,,201.38,81.2,,,percent of total billed charges,81.2% of total billed charges,80.95,32.64,,,percent of total billed charges,32.64% of total billed charges,183.52,74,,,percent of total billed charges,74% of total billed charges,183.52,74,,,percent of total billed charges,74% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,166.16,67,,,percent of total billed charges,67% of total billed charges,166.16,67,,,percent of total billed charges,67% of total billed charges,176.08,71,,,percent of total billed charges,71% of total billed charges,188.48,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,81.74,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,223.2,90,,,percent of total billed charges,90% of total billed charges,223.2,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,219.73,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,198.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,225.68,91,,,percent of total billed charges,91% of total billed charges,80.95,32.64,,,percent of total billed charges,32.64% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,83.33,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,79.36,32,,,percent of total billed charges,32% of total billed charges,79.36,32,,,percent of total billed charges,32% of total billed charges,228.16,92,,,percent of total billed charges,92% of total billed charges,42.34,228.16,
LEVEL 4 VISIT EST PATIENT,7901105,CDM,511,RC,99214,HCPCS,Outpatient,,,291,247.35,,236.29,81.2,,,percent of total billed charges,81.2% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,215.34,74,,,percent of total billed charges,74% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,194.97,67,,,percent of total billed charges,67% of total billed charges,206.61,71,,,percent of total billed charges,71% of total billed charges,221.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,95.91,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,261.9,90,,,percent of total billed charges,90% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,257.83,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,232.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,264.81,91,,,percent of total billed charges,91% of total billed charges,94.98,32.64,,,percent of total billed charges,32.64% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,97.78,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,93.12,32,,,percent of total billed charges,32% of total billed charges,93.12,32,,,percent of total billed charges,32% of total billed charges,267.72,92,,,percent of total billed charges,92% of total billed charges,42.34,267.72,
LEVEL 5 VISIT EST PATIENT,7901106,CDM,511,RC,99215,HCPCS,Outpatient,,,341,289.85,,276.89,81.2,,,percent of total billed charges,81.2% of total billed charges,111.3,32.64,,,percent of total billed charges,32.64% of total billed charges,252.34,74,,,percent of total billed charges,74% of total billed charges,252.34,74,,,percent of total billed charges,74% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,228.47,67,,,percent of total billed charges,67% of total billed charges,228.47,67,,,percent of total billed charges,67% of total billed charges,242.11,71,,,percent of total billed charges,71% of total billed charges,259.16,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,112.39,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,306.9,90,,,percent of total billed charges,90% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,302.13,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,272.8,80,,,percent of total billed charges,80% of total billed charges,272.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,310.31,91,,,percent of total billed charges,91% of total billed charges,111.3,32.64,,,percent of total billed charges,32.64% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,114.58,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,109.12,32,,,percent of total billed charges,32% of total billed charges,109.12,32,,,percent of total billed charges,32% of total billed charges,313.72,92,,,percent of total billed charges,92% of total billed charges,42.34,313.72,
PET SCAN SKULL TO MID THIGH,4500001,CDM,404,RC,78815,HCPCS,Outpatient,,,4444,3777.4,,3608.53,81.2,,,percent of total billed charges,81.2% of total billed charges,1450.52,32.64,,,percent of total billed charges,32.64% of total billed charges,3288.56,74,,,percent of total billed charges,74% of total billed charges,3288.56,74,,,percent of total billed charges,74% of total billed charges,1422.08,32,,,percent of total billed charges,32% of total billed charges,742.76,103,,,Fee Schedule,pays based on EAPG rates,1422.08,32,,,percent of total billed charges,32% of total billed charges,3155.24,71,,,percent of total billed charges,71% of total billed charges,3155.24,71,,,percent of total billed charges,71% of total billed charges,2977.48,67,,,percent of total billed charges,67% of total billed charges,2977.48,67,,,percent of total billed charges,67% of total billed charges,3155.24,71,,,percent of total billed charges,71% of total billed charges,3377.44,76,,,percent of total billed charges,76% of total billed charges,742.76,103,,,Fee Schedule,pays based on EAPG rates,1464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,757.19,105,,,Fee Schedule,pays based on EAPG rates,3999.6,90,,,percent of total billed charges,90% of total billed charges,3999.6,90,,,percent of total billed charges,90% of total billed charges,721.13,100,,,Fee Schedule,pays based on EAPG rates,3937.38,88.6,,,percent of total billed charges,88.6% of total billed charges,742.76,103,,,Fee Schedule,pays based on EAPG rates,1422.08,32,,,percent of total billed charges,32% of total billed charges,3555.2,80,,,percent of total billed charges,80% of total billed charges,3555.2,80,,,percent of total billed charges,80% of total billed charges,721.13,100,,,Fee Schedule,pays based on EAPG rates,4044.04,91,,,percent of total billed charges,91% of total billed charges,1450.52,32.64,,,percent of total billed charges,32.64% of total billed charges,1422.08,32,,,percent of total billed charges,32% of total billed charges,1493.18,33.6,,,percent of total billed charges,33.6% of total billed charges,742.76,103,,,Fee Schedule,pays based on EAPG rates,1422.08,32,,,percent of total billed charges,32% of total billed charges,1422.08,32,,,percent of total billed charges,32% of total billed charges,4088.48,92,,,percent of total billed charges,92% of total billed charges,721.13,4088.48,
PET SCAN WHOLE BODY,4500002,CDM,404,RC,78816,HCPCS,Outpatient,,,4444,3777.4,,3608.53,81.2,,,percent of total billed charges,81.2% of total billed charges,1450.52,32.64,,,percent of total billed charges,32.64% of total billed charges,3288.56,74,,,percent of total billed charges,74% of total billed charges,3288.56,74,,,percent of total billed charges,74% of total billed charges,1422.08,32,,,percent of total billed charges,32% of total billed charges,742.76,103,,,Fee Schedule,pays based on EAPG rates,1422.08,32,,,percent of total billed charges,32% of total billed charges,3155.24,71,,,percent of total billed charges,71% of total billed charges,3155.24,71,,,percent of total billed charges,71% of total billed charges,2977.48,67,,,percent of total billed charges,67% of total billed charges,2977.48,67,,,percent of total billed charges,67% of total billed charges,3155.24,71,,,percent of total billed charges,71% of total billed charges,3377.44,76,,,percent of total billed charges,76% of total billed charges,742.76,103,,,Fee Schedule,pays based on EAPG rates,1464.74,32.96,,,percent of total billed charges,32.96% of total billed charges,757.19,105,,,Fee Schedule,pays based on EAPG rates,3999.6,90,,,percent of total billed charges,90% of total billed charges,3999.6,90,,,percent of total billed charges,90% of total billed charges,721.13,100,,,Fee Schedule,pays based on EAPG rates,3937.38,88.6,,,percent of total billed charges,88.6% of total billed charges,742.76,103,,,Fee Schedule,pays based on EAPG rates,1422.08,32,,,percent of total billed charges,32% of total billed charges,3555.2,80,,,percent of total billed charges,80% of total billed charges,3555.2,80,,,percent of total billed charges,80% of total billed charges,721.13,100,,,Fee Schedule,pays based on EAPG rates,4044.04,91,,,percent of total billed charges,91% of total billed charges,1450.52,32.64,,,percent of total billed charges,32.64% of total billed charges,1422.08,32,,,percent of total billed charges,32% of total billed charges,1493.18,33.6,,,percent of total billed charges,33.6% of total billed charges,742.76,103,,,Fee Schedule,pays based on EAPG rates,1422.08,32,,,percent of total billed charges,32% of total billed charges,1422.08,32,,,percent of total billed charges,32% of total billed charges,4088.48,92,,,percent of total billed charges,92% of total billed charges,721.13,4088.48,
FDG-18,4500003,CDM,343,RC,A9552,HCPCS,Outpatient,,,148,125.8,,120.18,81.2,,,percent of total billed charges,81.2% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,109.52,74,,,percent of total billed charges,74% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,99.16,67,,,percent of total billed charges,67% of total billed charges,105.08,71,,,percent of total billed charges,71% of total billed charges,112.48,76,,,percent of total billed charges,76% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,48.78,32.96,,,percent of total billed charges,32.96% of total billed charges,83.76,105,,,Fee Schedule,pays based on EAPG rates,133.2,90,,,percent of total billed charges,90% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,131.13,88.6,,,percent of total billed charges,88.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,118.4,80,,,percent of total billed charges,80% of total billed charges,79.78,100,,,Fee Schedule,pays based on EAPG rates,134.68,91,,,percent of total billed charges,91% of total billed charges,48.31,32.64,,,percent of total billed charges,32.64% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,49.73,33.6,,,percent of total billed charges,33.6% of total billed charges,82.17,103,,,Fee Schedule,pays based on EAPG rates,47.36,32,,,percent of total billed charges,32% of total billed charges,47.36,32,,,percent of total billed charges,32% of total billed charges,136.16,92,,,percent of total billed charges,92% of total billed charges,47.36,136.16,
PT CANALITH REPOSITIONING PROCEDURE,3000202,CDM,420,RC,95992,HCPCS,Outpatient,,,137,116.45,,111.24,81.2,,,percent of total billed charges,81.2% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,101.38,74,,,percent of total billed charges,74% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,91.79,67,,,percent of total billed charges,67% of total billed charges,97.27,71,,,percent of total billed charges,71% of total billed charges,104.12,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,45.16,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,121.38,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,109.6,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,124.67,91,,,percent of total billed charges,91% of total billed charges,44.72,32.64,,,percent of total billed charges,32.64% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,46.03,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.84,32,,,percent of total billed charges,32% of total billed charges,43.84,32,,,percent of total billed charges,32% of total billed charges,126.04,92,,,percent of total billed charges,92% of total billed charges,43.84,126.04,
PT TRACTION MECH,3000003,CDM,420,RC,97012,HCPCS,Outpatient,,,185,157.25,,150.22,81.2,,,percent of total billed charges,81.2% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,140.6,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,60.98,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,163.91,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,168.35,91,,,percent of total billed charges,91% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,62.16,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,170.2,92,,,percent of total billed charges,92% of total billed charges,19.16,170.2,
PT ELEC STIM (SUPV),3000005,CDM,420,RC,97014,HCPCS,Outpatient,,,142,120.7,,115.3,81.2,,,percent of total billed charges,81.2% of total billed charges,46.35,32.64,,,percent of total billed charges,32.64% of total billed charges,105.08,74,,,percent of total billed charges,74% of total billed charges,105.08,74,,,percent of total billed charges,74% of total billed charges,45.44,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,45.44,32,,,percent of total billed charges,32% of total billed charges,100.82,71,,,percent of total billed charges,71% of total billed charges,100.82,71,,,percent of total billed charges,71% of total billed charges,95.14,67,,,percent of total billed charges,67% of total billed charges,95.14,67,,,percent of total billed charges,67% of total billed charges,100.82,71,,,percent of total billed charges,71% of total billed charges,107.92,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,46.8,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,127.8,90,,,percent of total billed charges,90% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,125.81,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,45.44,32,,,percent of total billed charges,32% of total billed charges,113.6,80,,,percent of total billed charges,80% of total billed charges,113.6,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,129.22,91,,,percent of total billed charges,91% of total billed charges,46.35,32.64,,,percent of total billed charges,32.64% of total billed charges,45.44,32,,,percent of total billed charges,32% of total billed charges,47.71,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,45.44,32,,,percent of total billed charges,32% of total billed charges,45.44,32,,,percent of total billed charges,32% of total billed charges,130.64,92,,,percent of total billed charges,92% of total billed charges,19.16,130.64,
PT TENS TX SUPV,3000013,CDM,420,RC,97014,HCPCS,Outpatient,,,191,162.35,,155.09,81.2,,,percent of total billed charges,81.2% of total billed charges,62.34,32.64,,,percent of total billed charges,32.64% of total billed charges,141.34,74,,,percent of total billed charges,74% of total billed charges,141.34,74,,,percent of total billed charges,74% of total billed charges,61.12,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,61.12,32,,,percent of total billed charges,32% of total billed charges,135.61,71,,,percent of total billed charges,71% of total billed charges,135.61,71,,,percent of total billed charges,71% of total billed charges,127.97,67,,,percent of total billed charges,67% of total billed charges,127.97,67,,,percent of total billed charges,67% of total billed charges,135.61,71,,,percent of total billed charges,71% of total billed charges,145.16,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,62.95,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,169.23,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,61.12,32,,,percent of total billed charges,32% of total billed charges,152.8,80,,,percent of total billed charges,80% of total billed charges,152.8,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,173.81,91,,,percent of total billed charges,91% of total billed charges,62.34,32.64,,,percent of total billed charges,32.64% of total billed charges,61.12,32,,,percent of total billed charges,32% of total billed charges,64.18,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,61.12,32,,,percent of total billed charges,32% of total billed charges,61.12,32,,,percent of total billed charges,32% of total billed charges,175.72,92,,,percent of total billed charges,92% of total billed charges,19.16,175.72,
PT VASOPNEUMATIC DEVICE,3000011,CDM,420,RC,97016,HCPCS,Outpatient,,,77,65.45,,62.52,81.2,,,percent of total billed charges,81.2% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,56.98,74,,,percent of total billed charges,74% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,51.59,67,,,percent of total billed charges,67% of total billed charges,54.67,71,,,percent of total billed charges,71% of total billed charges,58.52,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,25.38,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,68.22,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,61.6,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,70.07,91,,,percent of total billed charges,91% of total billed charges,25.13,32.64,,,percent of total billed charges,32.64% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,25.87,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,24.64,32,,,percent of total billed charges,32% of total billed charges,24.64,32,,,percent of total billed charges,32% of total billed charges,70.84,92,,,percent of total billed charges,92% of total billed charges,19.16,70.84,
PT PARAFFIN BATH,3000006,CDM,420,RC,97018,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,19.16,122.36,
PT DIATHERMY,3000008,CDM,420,RC,97024,HCPCS,Outpatient,,,107,90.95,,86.88,81.2,,,percent of total billed charges,81.2% of total billed charges,34.92,32.64,,,percent of total billed charges,32.64% of total billed charges,79.18,74,,,percent of total billed charges,74% of total billed charges,79.18,74,,,percent of total billed charges,74% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,71.69,67,,,percent of total billed charges,67% of total billed charges,71.69,67,,,percent of total billed charges,67% of total billed charges,75.97,71,,,percent of total billed charges,71% of total billed charges,81.32,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,35.27,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,96.3,90,,,percent of total billed charges,90% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,94.8,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,85.6,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,97.37,91,,,percent of total billed charges,91% of total billed charges,34.92,32.64,,,percent of total billed charges,32.64% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,35.95,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,34.24,32,,,percent of total billed charges,32% of total billed charges,34.24,32,,,percent of total billed charges,32% of total billed charges,98.44,92,,,percent of total billed charges,92% of total billed charges,19.16,98.44,
PT LASER,3000067,CDM,420,RC,97026,HCPCS,Outpatient,,,158,134.3,,128.3,81.2,,,percent of total billed charges,81.2% of total billed charges,51.57,32.64,,,percent of total billed charges,32.64% of total billed charges,116.92,74,,,percent of total billed charges,74% of total billed charges,116.92,74,,,percent of total billed charges,74% of total billed charges,50.56,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,50.56,32,,,percent of total billed charges,32% of total billed charges,112.18,71,,,percent of total billed charges,71% of total billed charges,112.18,71,,,percent of total billed charges,71% of total billed charges,105.86,67,,,percent of total billed charges,67% of total billed charges,105.86,67,,,percent of total billed charges,67% of total billed charges,112.18,71,,,percent of total billed charges,71% of total billed charges,120.08,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,52.08,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,142.2,90,,,percent of total billed charges,90% of total billed charges,142.2,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,139.99,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,50.56,32,,,percent of total billed charges,32% of total billed charges,126.4,80,,,percent of total billed charges,80% of total billed charges,126.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,143.78,91,,,percent of total billed charges,91% of total billed charges,51.57,32.64,,,percent of total billed charges,32.64% of total billed charges,50.56,32,,,percent of total billed charges,32% of total billed charges,53.09,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,50.56,32,,,percent of total billed charges,32% of total billed charges,50.56,32,,,percent of total billed charges,32% of total billed charges,145.36,92,,,percent of total billed charges,92% of total billed charges,19.16,145.36,
PT ELEC STIM EA 15M,3000010,CDM,420,RC,97032,HCPCS,Outpatient,,,173,147.05,,140.48,81.2,,,percent of total billed charges,81.2% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,131.48,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,57.02,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,155.7,90,,,percent of total billed charges,90% of total billed charges,155.7,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,153.28,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,157.43,91,,,percent of total billed charges,91% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,58.13,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,159.16,92,,,percent of total billed charges,92% of total billed charges,19.16,159.16,
PT IONTO EA 15 MIN,3000023,CDM,420,RC,97033,HCPCS,Outpatient,,,101,85.85,,82.01,81.2,,,percent of total billed charges,81.2% of total billed charges,32.97,32.64,,,percent of total billed charges,32.64% of total billed charges,74.74,74,,,percent of total billed charges,74% of total billed charges,74.74,74,,,percent of total billed charges,74% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,67.67,67,,,percent of total billed charges,67% of total billed charges,67.67,67,,,percent of total billed charges,67% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,76.76,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.29,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,89.49,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,91.91,91,,,percent of total billed charges,91% of total billed charges,32.97,32.64,,,percent of total billed charges,32.64% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,33.94,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,92.92,92,,,percent of total billed charges,92% of total billed charges,19.16,92.92,
PT US EA 15 MIN,3000001,CDM,420,RC,97035,HCPCS,Outpatient,,,173,147.05,,140.48,81.2,,,percent of total billed charges,81.2% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,131.48,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,57.02,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,155.7,90,,,percent of total billed charges,90% of total billed charges,155.7,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,153.28,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,157.43,91,,,percent of total billed charges,91% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,58.13,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,159.16,92,,,percent of total billed charges,92% of total billed charges,19.16,159.16,
PT EX (THERA) EA 15 MIN,3000019,CDM,420,RC,97110,HCPCS,Outpatient,,,144,122.4,,116.93,81.2,,,percent of total billed charges,81.2% of total billed charges,47,32.64,,,percent of total billed charges,32.64% of total billed charges,106.56,74,,,percent of total billed charges,74% of total billed charges,106.56,74,,,percent of total billed charges,74% of total billed charges,46.08,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,46.08,32,,,percent of total billed charges,32% of total billed charges,102.24,71,,,percent of total billed charges,71% of total billed charges,102.24,71,,,percent of total billed charges,71% of total billed charges,96.48,67,,,percent of total billed charges,67% of total billed charges,96.48,67,,,percent of total billed charges,67% of total billed charges,102.24,71,,,percent of total billed charges,71% of total billed charges,109.44,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,47.46,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,129.6,90,,,percent of total billed charges,90% of total billed charges,129.6,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,127.58,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,46.08,32,,,percent of total billed charges,32% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,115.2,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,131.04,91,,,percent of total billed charges,91% of total billed charges,47,32.64,,,percent of total billed charges,32.64% of total billed charges,46.08,32,,,percent of total billed charges,32% of total billed charges,48.38,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,46.08,32,,,percent of total billed charges,32% of total billed charges,46.08,32,,,percent of total billed charges,32% of total billed charges,132.48,92,,,percent of total billed charges,92% of total billed charges,46.08,132.48,
PT NEUROMUSC RE-ED/15M,3000033,CDM,420,RC,97112,HCPCS,Outpatient,,,135,114.75,,109.62,81.2,,,percent of total billed charges,81.2% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,99.9,74,,,percent of total billed charges,74% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,90.45,67,,,percent of total billed charges,67% of total billed charges,95.85,71,,,percent of total billed charges,71% of total billed charges,102.6,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,44.5,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,119.61,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,108,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,122.85,91,,,percent of total billed charges,91% of total billed charges,44.06,32.64,,,percent of total billed charges,32.64% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,45.36,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,43.2,32,,,percent of total billed charges,32% of total billed charges,43.2,32,,,percent of total billed charges,32% of total billed charges,124.2,92,,,percent of total billed charges,92% of total billed charges,43.2,124.2,
PT GT TRNG EA 15 MIN,3000018,CDM,420,RC,97116,HCPCS,Outpatient,,,105,89.25,,85.26,81.2,,,percent of total billed charges,81.2% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,77.7,74,,,percent of total billed charges,74% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,70.35,67,,,percent of total billed charges,67% of total billed charges,74.55,71,,,percent of total billed charges,71% of total billed charges,79.8,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,34.61,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,94.5,90,,,percent of total billed charges,90% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,93.03,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,84,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,95.55,91,,,percent of total billed charges,91% of total billed charges,34.27,32.64,,,percent of total billed charges,32.64% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,35.28,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.6,32,,,percent of total billed charges,32% of total billed charges,33.6,32,,,percent of total billed charges,32% of total billed charges,96.6,92,,,percent of total billed charges,92% of total billed charges,19.16,96.6,
PT MASSAGE Q 15 MIN,3000009,CDM,420,RC,97124,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,19.16,122.36,
PT MAN TECH W/MASS/15M,3000012,CDM,420,RC,97140,HCPCS,Outpatient,,,145,123.25,,117.74,81.2,,,percent of total billed charges,81.2% of total billed charges,47.33,32.64,,,percent of total billed charges,32.64% of total billed charges,107.3,74,,,percent of total billed charges,74% of total billed charges,107.3,74,,,percent of total billed charges,74% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,97.15,67,,,percent of total billed charges,67% of total billed charges,97.15,67,,,percent of total billed charges,67% of total billed charges,102.95,71,,,percent of total billed charges,71% of total billed charges,110.2,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,47.79,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,130.5,90,,,percent of total billed charges,90% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,128.47,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,116,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,131.95,91,,,percent of total billed charges,91% of total billed charges,47.33,32.64,,,percent of total billed charges,32.64% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,48.72,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,46.4,32,,,percent of total billed charges,32% of total billed charges,46.4,32,,,percent of total billed charges,32% of total billed charges,133.4,92,,,percent of total billed charges,92% of total billed charges,46.4,133.4,
PT EVAL PT-LOW COMPLEXITY,3000203,CDM,424,RC,97161,HCPCS,Outpatient,,,296,251.6,,240.35,81.2,,,percent of total billed charges,81.2% of total billed charges,96.61,32.64,,,percent of total billed charges,32.64% of total billed charges,219.04,74,,,percent of total billed charges,74% of total billed charges,219.04,74,,,percent of total billed charges,74% of total billed charges,94.72,32,,,percent of total billed charges,32% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,94.72,32,,,percent of total billed charges,32% of total billed charges,210.16,71,,,percent of total billed charges,71% of total billed charges,210.16,71,,,percent of total billed charges,71% of total billed charges,198.32,67,,,percent of total billed charges,67% of total billed charges,198.32,67,,,percent of total billed charges,67% of total billed charges,210.16,71,,,percent of total billed charges,71% of total billed charges,224.96,76,,,percent of total billed charges,76% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,97.56,32.96,,,percent of total billed charges,32.96% of total billed charges,60.27,105,,,Fee Schedule,pays based on EAPG rates,266.4,90,,,percent of total billed charges,90% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,57.4,100,,,Fee Schedule,pays based on EAPG rates,262.26,88.6,,,percent of total billed charges,88.6% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,94.72,32,,,percent of total billed charges,32% of total billed charges,236.8,80,,,percent of total billed charges,80% of total billed charges,236.8,80,,,percent of total billed charges,80% of total billed charges,57.4,100,,,Fee Schedule,pays based on EAPG rates,269.36,91,,,percent of total billed charges,91% of total billed charges,96.61,32.64,,,percent of total billed charges,32.64% of total billed charges,94.72,32,,,percent of total billed charges,32% of total billed charges,99.46,33.6,,,percent of total billed charges,33.6% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,94.72,32,,,percent of total billed charges,32% of total billed charges,94.72,32,,,percent of total billed charges,32% of total billed charges,272.32,92,,,percent of total billed charges,92% of total billed charges,57.4,272.32,
PT EVAL PT-MODERATE COMPLEXITY,3000204,CDM,424,RC,97162,HCPCS,Outpatient,,,303,257.55,,246.04,81.2,,,percent of total billed charges,81.2% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,230.28,76,,,percent of total billed charges,76% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,99.87,32.96,,,percent of total billed charges,32.96% of total billed charges,60.27,105,,,Fee Schedule,pays based on EAPG rates,272.7,90,,,percent of total billed charges,90% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,57.4,100,,,Fee Schedule,pays based on EAPG rates,268.46,88.6,,,percent of total billed charges,88.6% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,57.4,100,,,Fee Schedule,pays based on EAPG rates,275.73,91,,,percent of total billed charges,91% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,101.81,33.6,,,percent of total billed charges,33.6% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,278.76,92,,,percent of total billed charges,92% of total billed charges,57.4,278.76,
PT EVAL PT-HIGH COMPLEXITY,3000205,CDM,424,RC,97163,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,60.27,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,57.4,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,57.4,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,57.4,284.28,
PT RE-EVAL PT,3000035,CDM,424,RC,97164,HCPCS,Outpatient,,,129,109.65,,104.75,81.2,,,percent of total billed charges,81.2% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,95.46,74,,,percent of total billed charges,74% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,86.43,67,,,percent of total billed charges,67% of total billed charges,91.59,71,,,percent of total billed charges,71% of total billed charges,98.04,76,,,percent of total billed charges,76% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,42.52,32.96,,,percent of total billed charges,32.96% of total billed charges,60.27,105,,,Fee Schedule,pays based on EAPG rates,116.1,90,,,percent of total billed charges,90% of total billed charges,116.1,90,,,percent of total billed charges,90% of total billed charges,57.4,100,,,Fee Schedule,pays based on EAPG rates,114.29,88.6,,,percent of total billed charges,88.6% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,103.2,80,,,percent of total billed charges,80% of total billed charges,57.4,100,,,Fee Schedule,pays based on EAPG rates,117.39,91,,,percent of total billed charges,91% of total billed charges,42.11,32.64,,,percent of total billed charges,32.64% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,43.34,33.6,,,percent of total billed charges,33.6% of total billed charges,59.13,103,,,Fee Schedule,pays based on EAPG rates,41.28,32,,,percent of total billed charges,32% of total billed charges,41.28,32,,,percent of total billed charges,32% of total billed charges,118.68,92,,,percent of total billed charges,92% of total billed charges,41.28,118.68,
PT THERAPEUTIC ACT/15M,3000046,CDM,420,RC,97530,HCPCS,Outpatient,,,185,157.25,,150.22,81.2,,,percent of total billed charges,81.2% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,140.6,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,60.98,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,163.91,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,168.35,91,,,percent of total billed charges,91% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,62.16,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,170.2,92,,,percent of total billed charges,92% of total billed charges,52.41,170.2,
PT SENS INTEGR TCH/15M,3000048,CDM,420,RC,97533,HCPCS,Outpatient,,,160,136,,129.92,81.2,,,percent of total billed charges,81.2% of total billed charges,52.22,32.64,,,percent of total billed charges,32.64% of total billed charges,118.4,74,,,percent of total billed charges,74% of total billed charges,118.4,74,,,percent of total billed charges,74% of total billed charges,51.2,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,51.2,32,,,percent of total billed charges,32% of total billed charges,113.6,71,,,percent of total billed charges,71% of total billed charges,113.6,71,,,percent of total billed charges,71% of total billed charges,107.2,67,,,percent of total billed charges,67% of total billed charges,107.2,67,,,percent of total billed charges,67% of total billed charges,113.6,71,,,percent of total billed charges,71% of total billed charges,121.6,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,52.74,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,144,90,,,percent of total billed charges,90% of total billed charges,144,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,141.76,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,51.2,32,,,percent of total billed charges,32% of total billed charges,128,80,,,percent of total billed charges,80% of total billed charges,128,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,145.6,91,,,percent of total billed charges,91% of total billed charges,52.22,32.64,,,percent of total billed charges,32.64% of total billed charges,51.2,32,,,percent of total billed charges,32% of total billed charges,53.76,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,51.2,32,,,percent of total billed charges,32% of total billed charges,51.2,32,,,percent of total billed charges,32% of total billed charges,147.2,92,,,percent of total billed charges,92% of total billed charges,51.2,147.2,
PT ADL TRNG EA 15 MIN,3000022,CDM,420,RC,97535,HCPCS,Outpatient,,,104,88.4,,84.45,81.2,,,percent of total billed charges,81.2% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,76.96,74,,,percent of total billed charges,74% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,69.68,67,,,percent of total billed charges,67% of total billed charges,73.84,71,,,percent of total billed charges,71% of total billed charges,79.04,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,34.28,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,92.14,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,83.2,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,94.64,91,,,percent of total billed charges,91% of total billed charges,33.95,32.64,,,percent of total billed charges,32.64% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,34.94,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,33.28,32,,,percent of total billed charges,32% of total billed charges,33.28,32,,,percent of total billed charges,32% of total billed charges,95.68,92,,,percent of total billed charges,92% of total billed charges,19.16,95.68,
PT WHLCHAIR MGMT/15M,3000040,CDM,420,RC,97542,HCPCS,Outpatient,,,90,76.5,,73.08,81.2,,,percent of total billed charges,81.2% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,68.4,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,29.66,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,79.74,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,81.9,91,,,percent of total billed charges,91% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,30.24,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,82.8,92,,,percent of total billed charges,92% of total billed charges,28.8,82.8,
PT WRK HRD/RCN INTL 2H,3000206,CDM,420,RC,97545,HCPCS,Outpatient,,,334,283.9,,271.21,81.2,,,percent of total billed charges,81.2% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,253.84,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,110.09,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,295.92,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,303.94,91,,,percent of total billed charges,91% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,112.22,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,307.28,92,,,percent of total billed charges,92% of total billed charges,19.16,307.28,
PT WRK HRD/COND/EACH ADDL HR,3000042,CDM,420,RC,97546,HCPCS,Outpatient,,,353,300.05,,286.64,81.2,,,percent of total billed charges,81.2% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,268.28,76,,,percent of total billed charges,76% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,116.35,32.96,,,percent of total billed charges,32.96% of total billed charges,20.11,105,,,Fee Schedule,pays based on EAPG rates,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,312.76,88.6,,,percent of total billed charges,88.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,19.16,100,,,Fee Schedule,pays based on EAPG rates,321.23,91,,,percent of total billed charges,91% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,118.61,33.6,,,percent of total billed charges,33.6% of total billed charges,19.73,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,324.76,92,,,percent of total billed charges,92% of total billed charges,19.16,324.76,
WOUND DEBRID,3000043,CDM,421,RC,97602,HCPCS,Outpatient,,,278,236.3,,225.74,81.2,,,percent of total billed charges,81.2% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,211.28,76,,,percent of total billed charges,76% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,91.63,32.96,,,percent of total billed charges,32.96% of total billed charges,154.68,105,,,Fee Schedule,pays based on EAPG rates,250.2,90,,,percent of total billed charges,90% of total billed charges,250.2,90,,,percent of total billed charges,90% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,246.31,88.6,,,percent of total billed charges,88.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,147.31,100,,,Fee Schedule,pays based on EAPG rates,252.98,91,,,percent of total billed charges,91% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,93.41,33.6,,,percent of total billed charges,33.6% of total billed charges,151.73,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,255.76,92,,,percent of total billed charges,92% of total billed charges,88.96,255.76,
PT PRFRMNC TEST W/WRITTEN REPORT/15 MINS,3000056,CDM,420,RC,97750,HCPCS,Outpatient,,,117,99.45,,95,81.2,,,percent of total billed charges,81.2% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,86.58,74,,,percent of total billed charges,74% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,78.39,67,,,percent of total billed charges,67% of total billed charges,83.07,71,,,percent of total billed charges,71% of total billed charges,88.92,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,38.56,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,105.3,90,,,percent of total billed charges,90% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,103.66,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,93.6,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,106.47,91,,,percent of total billed charges,91% of total billed charges,38.19,32.64,,,percent of total billed charges,32.64% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,39.31,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,37.44,32,,,percent of total billed charges,32% of total billed charges,37.44,32,,,percent of total billed charges,32% of total billed charges,107.64,92,,,percent of total billed charges,92% of total billed charges,37.44,107.64,
PT ORTHTC TRNG Q 15M INITIAL ENCOUNTER,3000015,CDM,420,RC,97760,HCPCS,Outpatient,,,99,84.15,,80.39,81.2,,,percent of total billed charges,81.2% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,73.26,74,,,percent of total billed charges,74% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,66.33,67,,,percent of total billed charges,67% of total billed charges,70.29,71,,,percent of total billed charges,71% of total billed charges,75.24,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.63,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,87.71,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,79.2,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,90.09,91,,,percent of total billed charges,91% of total billed charges,32.31,32.64,,,percent of total billed charges,32.64% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,33.26,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,31.68,32,,,percent of total billed charges,32% of total billed charges,31.68,32,,,percent of total billed charges,32% of total billed charges,91.08,92,,,percent of total billed charges,92% of total billed charges,31.68,91.08,
PT PRSTHTC TRNG Q 15M INITITAL ENCOUNTER,3000021,CDM,420,RC,97761,HCPCS,Outpatient,,,101,85.85,,82.01,81.2,,,percent of total billed charges,81.2% of total billed charges,32.97,32.64,,,percent of total billed charges,32.64% of total billed charges,74.74,74,,,percent of total billed charges,74% of total billed charges,74.74,74,,,percent of total billed charges,74% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,67.67,67,,,percent of total billed charges,67% of total billed charges,67.67,67,,,percent of total billed charges,67% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,76.76,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,33.29,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,89.49,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,91.91,91,,,percent of total billed charges,91% of total billed charges,32.97,32.64,,,percent of total billed charges,32.64% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,33.94,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,92.92,92,,,percent of total billed charges,92% of total billed charges,32.32,92.92,
PT BWC WRK HRD/COND 15 MIN EA,3000041,CDM,420,RC,W0710,HCPCS,Outpatient,,,44,37.4,,35.73,81.2,,,percent of total billed charges,81.2% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,32.56,74,,,percent of total billed charges,74% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,14.08,32,,,percent of total billed charges,32% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,29.48,67,,,percent of total billed charges,67% of total billed charges,31.24,71,,,percent of total billed charges,71% of total billed charges,33.44,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,14.5,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,39.6,90,,,percent of total billed charges,90% of total billed charges,39.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,38.98,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,14.08,32,,,percent of total billed charges,32% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,35.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,40.04,91,,,percent of total billed charges,91% of total billed charges,14.36,32.64,,,percent of total billed charges,32.64% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,14.78,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,14.08,32,,,percent of total billed charges,32% of total billed charges,14.08,32,,,percent of total billed charges,32% of total billed charges,40.48,92,,,percent of total billed charges,92% of total billed charges,14.08,40.48,
PT ORTHTIC EVAL/15 MIN,3000017,CDM,420,RC,,,Outpatient,,,165,140.25,,133.98,81.2,,,percent of total billed charges,81.2% of total billed charges,53.86,32.64,,,percent of total billed charges,32.64% of total billed charges,122.1,74,,,percent of total billed charges,74% of total billed charges,122.1,74,,,percent of total billed charges,74% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,52.8,32,,,percent of total billed charges,32% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,110.55,67,,,percent of total billed charges,67% of total billed charges,110.55,67,,,percent of total billed charges,67% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,125.4,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,54.38,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,148.5,90,,,percent of total billed charges,90% of total billed charges,148.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,146.19,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,52.8,32,,,percent of total billed charges,32% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,150.15,91,,,percent of total billed charges,91% of total billed charges,53.86,32.64,,,percent of total billed charges,32.64% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,55.44,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,52.8,32,,,percent of total billed charges,32% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,151.8,92,,,percent of total billed charges,92% of total billed charges,52.8,151.8,
ST REMVL IMPCTD CERUMEN,3200064,CDM,440,RC,69210,HCPCS,Outpatient,,,187,158.95,,151.84,81.2,,,percent of total billed charges,81.2% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,138.38,74,,,percent of total billed charges,74% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,125.29,67,,,percent of total billed charges,67% of total billed charges,132.77,71,,,percent of total billed charges,71% of total billed charges,142.12,76,,,percent of total billed charges,76% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,61.64,32.96,,,percent of total billed charges,32.96% of total billed charges,69.63,105,,,Fee Schedule,pays based on EAPG rates,168.3,90,,,percent of total billed charges,90% of total billed charges,168.3,90,,,percent of total billed charges,90% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,165.68,88.6,,,percent of total billed charges,88.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,149.6,80,,,percent of total billed charges,80% of total billed charges,66.31,100,,,Fee Schedule,pays based on EAPG rates,170.17,91,,,percent of total billed charges,91% of total billed charges,61.04,32.64,,,percent of total billed charges,32.64% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,62.83,33.6,,,percent of total billed charges,33.6% of total billed charges,68.3,103,,,Fee Schedule,pays based on EAPG rates,59.84,32,,,percent of total billed charges,32% of total billed charges,59.84,32,,,percent of total billed charges,32% of total billed charges,172.04,92,,,percent of total billed charges,92% of total billed charges,59.84,172.04,
ST SPCH THER,3200003,CDM,441,RC,92507,HCPCS,Outpatient,,,167,141.95,,135.6,81.2,,,percent of total billed charges,81.2% of total billed charges,54.51,32.64,,,percent of total billed charges,32.64% of total billed charges,123.58,74,,,percent of total billed charges,74% of total billed charges,123.58,74,,,percent of total billed charges,74% of total billed charges,53.44,32,,,percent of total billed charges,32% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,53.44,32,,,percent of total billed charges,32% of total billed charges,118.57,71,,,percent of total billed charges,71% of total billed charges,118.57,71,,,percent of total billed charges,71% of total billed charges,111.89,67,,,percent of total billed charges,67% of total billed charges,111.89,67,,,percent of total billed charges,67% of total billed charges,118.57,71,,,percent of total billed charges,71% of total billed charges,126.92,76,,,percent of total billed charges,76% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,55.04,32.96,,,percent of total billed charges,32.96% of total billed charges,45.75,105,,,Fee Schedule,pays based on EAPG rates,150.3,90,,,percent of total billed charges,90% of total billed charges,150.3,90,,,percent of total billed charges,90% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,147.96,88.6,,,percent of total billed charges,88.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,53.44,32,,,percent of total billed charges,32% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,151.97,91,,,percent of total billed charges,91% of total billed charges,54.51,32.64,,,percent of total billed charges,32.64% of total billed charges,53.44,32,,,percent of total billed charges,32% of total billed charges,56.11,33.6,,,percent of total billed charges,33.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,53.44,32,,,percent of total billed charges,32% of total billed charges,53.44,32,,,percent of total billed charges,32% of total billed charges,153.64,92,,,percent of total billed charges,92% of total billed charges,43.57,153.64,
ST SPCH GRP THER/15 MINS,3200027,CDM,441,RC,92508,HCPCS,Outpatient,,,101,85.85,,82.01,81.2,,,percent of total billed charges,81.2% of total billed charges,32.97,32.64,,,percent of total billed charges,32.64% of total billed charges,74.74,74,,,percent of total billed charges,74% of total billed charges,74.74,74,,,percent of total billed charges,74% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,67.67,67,,,percent of total billed charges,67% of total billed charges,67.67,67,,,percent of total billed charges,67% of total billed charges,71.71,71,,,percent of total billed charges,71% of total billed charges,76.76,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,33.29,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,89.49,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,80.8,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,91.91,91,,,percent of total billed charges,91% of total billed charges,32.97,32.64,,,percent of total billed charges,32.64% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,33.94,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,32.32,32,,,percent of total billed charges,32% of total billed charges,32.32,32,,,percent of total billed charges,32% of total billed charges,92.92,92,,,percent of total billed charges,92% of total billed charges,32.32,92.92,
ST SPCH EVAL OF SPEECH FLUENCY,3200347,CDM,444,RC,92521,HCPCS,Outpatient,,,303,257.55,,246.04,81.2,,,percent of total billed charges,81.2% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,230.28,76,,,percent of total billed charges,76% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,99.87,32.96,,,percent of total billed charges,32.96% of total billed charges,45.75,105,,,Fee Schedule,pays based on EAPG rates,272.7,90,,,percent of total billed charges,90% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,268.46,88.6,,,percent of total billed charges,88.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,275.73,91,,,percent of total billed charges,91% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,101.81,33.6,,,percent of total billed charges,33.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,278.76,92,,,percent of total billed charges,92% of total billed charges,43.57,278.76,
ST SPCH EVAL SOUND PRODUCTION,3200348,CDM,444,RC,92522,HCPCS,Outpatient,,,428,363.8,,347.54,81.2,,,percent of total billed charges,81.2% of total billed charges,139.7,32.64,,,percent of total billed charges,32.64% of total billed charges,316.72,74,,,percent of total billed charges,74% of total billed charges,316.72,74,,,percent of total billed charges,74% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,286.76,67,,,percent of total billed charges,67% of total billed charges,286.76,67,,,percent of total billed charges,67% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,325.28,76,,,percent of total billed charges,76% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,141.07,32.96,,,percent of total billed charges,32.96% of total billed charges,45.75,105,,,Fee Schedule,pays based on EAPG rates,385.2,90,,,percent of total billed charges,90% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,379.21,88.6,,,percent of total billed charges,88.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,342.4,80,,,percent of total billed charges,80% of total billed charges,342.4,80,,,percent of total billed charges,80% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,389.48,91,,,percent of total billed charges,91% of total billed charges,139.7,32.64,,,percent of total billed charges,32.64% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,143.81,33.6,,,percent of total billed charges,33.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,393.76,92,,,percent of total billed charges,92% of total billed charges,43.57,393.76,
ST SPCH EVAL SND PRDCTN W/LNG CMP EX,3200349,CDM,444,RC,92523,HCPCS,Outpatient,,,428,363.8,,347.54,81.2,,,percent of total billed charges,81.2% of total billed charges,139.7,32.64,,,percent of total billed charges,32.64% of total billed charges,316.72,74,,,percent of total billed charges,74% of total billed charges,316.72,74,,,percent of total billed charges,74% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,286.76,67,,,percent of total billed charges,67% of total billed charges,286.76,67,,,percent of total billed charges,67% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,325.28,76,,,percent of total billed charges,76% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,141.07,32.96,,,percent of total billed charges,32.96% of total billed charges,45.75,105,,,Fee Schedule,pays based on EAPG rates,385.2,90,,,percent of total billed charges,90% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,379.21,88.6,,,percent of total billed charges,88.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,342.4,80,,,percent of total billed charges,80% of total billed charges,342.4,80,,,percent of total billed charges,80% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,389.48,91,,,percent of total billed charges,91% of total billed charges,139.7,32.64,,,percent of total billed charges,32.64% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,143.81,33.6,,,percent of total billed charges,33.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,393.76,92,,,percent of total billed charges,92% of total billed charges,43.57,393.76,
ST BHVRL & QLTV ANLYSS VOICE & RESONANCE,3200350,CDM,444,RC,92524,HCPCS,Outpatient,,,303,257.55,,246.04,81.2,,,percent of total billed charges,81.2% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,224.22,74,,,percent of total billed charges,74% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,203.01,67,,,percent of total billed charges,67% of total billed charges,215.13,71,,,percent of total billed charges,71% of total billed charges,230.28,76,,,percent of total billed charges,76% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,99.87,32.96,,,percent of total billed charges,32.96% of total billed charges,45.75,105,,,Fee Schedule,pays based on EAPG rates,272.7,90,,,percent of total billed charges,90% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,268.46,88.6,,,percent of total billed charges,88.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,242.4,80,,,percent of total billed charges,80% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,275.73,91,,,percent of total billed charges,91% of total billed charges,98.9,32.64,,,percent of total billed charges,32.64% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,101.81,33.6,,,percent of total billed charges,33.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,96.96,32,,,percent of total billed charges,32% of total billed charges,96.96,32,,,percent of total billed charges,32% of total billed charges,278.76,92,,,percent of total billed charges,92% of total billed charges,43.57,278.76,
ST SWALL THER,3200022,CDM,441,RC,92526,HCPCS,Outpatient,,,167,141.95,,135.6,81.2,,,percent of total billed charges,81.2% of total billed charges,54.51,32.64,,,percent of total billed charges,32.64% of total billed charges,123.58,74,,,percent of total billed charges,74% of total billed charges,123.58,74,,,percent of total billed charges,74% of total billed charges,53.44,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,53.44,32,,,percent of total billed charges,32% of total billed charges,118.57,71,,,percent of total billed charges,71% of total billed charges,118.57,71,,,percent of total billed charges,71% of total billed charges,111.89,67,,,percent of total billed charges,67% of total billed charges,111.89,67,,,percent of total billed charges,67% of total billed charges,118.57,71,,,percent of total billed charges,71% of total billed charges,126.92,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,55.04,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,150.3,90,,,percent of total billed charges,90% of total billed charges,150.3,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,147.96,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,53.44,32,,,percent of total billed charges,32% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,133.6,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,151.97,91,,,percent of total billed charges,91% of total billed charges,54.51,32.64,,,percent of total billed charges,32.64% of total billed charges,53.44,32,,,percent of total billed charges,32% of total billed charges,56.11,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,53.44,32,,,percent of total billed charges,32% of total billed charges,53.44,32,,,percent of total billed charges,32% of total billed charges,153.64,92,,,percent of total billed charges,92% of total billed charges,52.41,153.64,
ST AUDIO SCREENING,3200001,CDM,434,RC,92551,HCPCS,Outpatient,,,60,51,,48.72,81.2,,,percent of total billed charges,81.2% of total billed charges,19.58,32.64,,,percent of total billed charges,32.64% of total billed charges,44.4,74,,,percent of total billed charges,74% of total billed charges,44.4,74,,,percent of total billed charges,74% of total billed charges,19.2,32,,,percent of total billed charges,32% of total billed charges,25.38,103,,,Fee Schedule,pays based on EAPG rates,19.2,32,,,percent of total billed charges,32% of total billed charges,42.6,71,,,percent of total billed charges,71% of total billed charges,42.6,71,,,percent of total billed charges,71% of total billed charges,40.2,67,,,percent of total billed charges,67% of total billed charges,40.2,67,,,percent of total billed charges,67% of total billed charges,42.6,71,,,percent of total billed charges,71% of total billed charges,45.6,76,,,percent of total billed charges,76% of total billed charges,25.38,103,,,Fee Schedule,pays based on EAPG rates,19.78,32.96,,,percent of total billed charges,32.96% of total billed charges,25.87,105,,,Fee Schedule,pays based on EAPG rates,54,90,,,percent of total billed charges,90% of total billed charges,54,90,,,percent of total billed charges,90% of total billed charges,24.64,100,,,Fee Schedule,pays based on EAPG rates,53.16,88.6,,,percent of total billed charges,88.6% of total billed charges,25.38,103,,,Fee Schedule,pays based on EAPG rates,19.2,32,,,percent of total billed charges,32% of total billed charges,48,80,,,percent of total billed charges,80% of total billed charges,48,80,,,percent of total billed charges,80% of total billed charges,24.64,100,,,Fee Schedule,pays based on EAPG rates,54.6,91,,,percent of total billed charges,91% of total billed charges,19.58,32.64,,,percent of total billed charges,32.64% of total billed charges,19.2,32,,,percent of total billed charges,32% of total billed charges,20.16,33.6,,,percent of total billed charges,33.6% of total billed charges,25.38,103,,,Fee Schedule,pays based on EAPG rates,19.2,32,,,percent of total billed charges,32% of total billed charges,19.2,32,,,percent of total billed charges,32% of total billed charges,55.2,92,,,percent of total billed charges,92% of total billed charges,19.2,55.2,
ST EVAL OF VCE PRSTHTC,3200056,CDM,440,RC,92597,HCPCS,Outpatient,,,428,363.8,,347.54,81.2,,,percent of total billed charges,81.2% of total billed charges,139.7,32.64,,,percent of total billed charges,32.64% of total billed charges,316.72,74,,,percent of total billed charges,74% of total billed charges,316.72,74,,,percent of total billed charges,74% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,286.76,67,,,percent of total billed charges,67% of total billed charges,286.76,67,,,percent of total billed charges,67% of total billed charges,303.88,71,,,percent of total billed charges,71% of total billed charges,325.28,76,,,percent of total billed charges,76% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,141.07,32.96,,,percent of total billed charges,32.96% of total billed charges,45.75,105,,,Fee Schedule,pays based on EAPG rates,385.2,90,,,percent of total billed charges,90% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,379.21,88.6,,,percent of total billed charges,88.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,342.4,80,,,percent of total billed charges,80% of total billed charges,342.4,80,,,percent of total billed charges,80% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,389.48,91,,,percent of total billed charges,91% of total billed charges,139.7,32.64,,,percent of total billed charges,32.64% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,143.81,33.6,,,percent of total billed charges,33.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,136.96,32,,,percent of total billed charges,32% of total billed charges,136.96,32,,,percent of total billed charges,32% of total billed charges,393.76,92,,,percent of total billed charges,92% of total billed charges,43.57,393.76,
ST EVAL SPCH DVC 1ST HR,3200057,CDM,440,RC,92607,HCPCS,Outpatient,,,709,602.65,,575.71,81.2,,,percent of total billed charges,81.2% of total billed charges,231.42,32.64,,,percent of total billed charges,32.64% of total billed charges,524.66,74,,,percent of total billed charges,74% of total billed charges,524.66,74,,,percent of total billed charges,74% of total billed charges,226.88,32,,,percent of total billed charges,32% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,226.88,32,,,percent of total billed charges,32% of total billed charges,503.39,71,,,percent of total billed charges,71% of total billed charges,503.39,71,,,percent of total billed charges,71% of total billed charges,475.03,67,,,percent of total billed charges,67% of total billed charges,475.03,67,,,percent of total billed charges,67% of total billed charges,503.39,71,,,percent of total billed charges,71% of total billed charges,538.84,76,,,percent of total billed charges,76% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,233.69,32.96,,,percent of total billed charges,32.96% of total billed charges,45.75,105,,,Fee Schedule,pays based on EAPG rates,638.1,90,,,percent of total billed charges,90% of total billed charges,638.1,90,,,percent of total billed charges,90% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,628.17,88.6,,,percent of total billed charges,88.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,226.88,32,,,percent of total billed charges,32% of total billed charges,567.2,80,,,percent of total billed charges,80% of total billed charges,567.2,80,,,percent of total billed charges,80% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,645.19,91,,,percent of total billed charges,91% of total billed charges,231.42,32.64,,,percent of total billed charges,32.64% of total billed charges,226.88,32,,,percent of total billed charges,32% of total billed charges,238.22,33.6,,,percent of total billed charges,33.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,226.88,32,,,percent of total billed charges,32% of total billed charges,226.88,32,,,percent of total billed charges,32% of total billed charges,652.28,92,,,percent of total billed charges,92% of total billed charges,43.57,652.28,
ST EV SPCH DEV/ADDT 30M,3200058,CDM,440,RC,92608,HCPCS,Outpatient,,,150,127.5,,121.8,81.2,,,percent of total billed charges,81.2% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,111,74,,,percent of total billed charges,74% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,100.5,67,,,percent of total billed charges,67% of total billed charges,106.5,71,,,percent of total billed charges,71% of total billed charges,114,76,,,percent of total billed charges,76% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,49.44,32.96,,,percent of total billed charges,32.96% of total billed charges,45.75,105,,,Fee Schedule,pays based on EAPG rates,135,90,,,percent of total billed charges,90% of total billed charges,135,90,,,percent of total billed charges,90% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,132.9,88.6,,,percent of total billed charges,88.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,120,80,,,percent of total billed charges,80% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,136.5,91,,,percent of total billed charges,91% of total billed charges,48.96,32.64,,,percent of total billed charges,32.64% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,50.4,33.6,,,percent of total billed charges,33.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,48,32,,,percent of total billed charges,32% of total billed charges,48,32,,,percent of total billed charges,32% of total billed charges,138,92,,,percent of total billed charges,92% of total billed charges,43.57,138,
ST TRNG&FTTNG SPCH GEN,3200059,CDM,440,RC,92609,HCPCS,Outpatient,,,349,296.65,,283.39,81.2,,,percent of total billed charges,81.2% of total billed charges,113.91,32.64,,,percent of total billed charges,32.64% of total billed charges,258.26,74,,,percent of total billed charges,74% of total billed charges,258.26,74,,,percent of total billed charges,74% of total billed charges,111.68,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,111.68,32,,,percent of total billed charges,32% of total billed charges,247.79,71,,,percent of total billed charges,71% of total billed charges,247.79,71,,,percent of total billed charges,71% of total billed charges,233.83,67,,,percent of total billed charges,67% of total billed charges,233.83,67,,,percent of total billed charges,67% of total billed charges,247.79,71,,,percent of total billed charges,71% of total billed charges,265.24,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,115.03,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,314.1,90,,,percent of total billed charges,90% of total billed charges,314.1,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,309.21,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,111.68,32,,,percent of total billed charges,32% of total billed charges,279.2,80,,,percent of total billed charges,80% of total billed charges,279.2,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,317.59,91,,,percent of total billed charges,91% of total billed charges,113.91,32.64,,,percent of total billed charges,32.64% of total billed charges,111.68,32,,,percent of total billed charges,32% of total billed charges,117.26,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,111.68,32,,,percent of total billed charges,32% of total billed charges,111.68,32,,,percent of total billed charges,32% of total billed charges,321.08,92,,,percent of total billed charges,92% of total billed charges,52.41,321.08,
ST SWALL EVAL,3200005,CDM,444,RC,92610,HCPCS,Outpatient,,,296,251.6,,240.35,81.2,,,percent of total billed charges,81.2% of total billed charges,96.61,32.64,,,percent of total billed charges,32.64% of total billed charges,219.04,74,,,percent of total billed charges,74% of total billed charges,219.04,74,,,percent of total billed charges,74% of total billed charges,94.72,32,,,percent of total billed charges,32% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,94.72,32,,,percent of total billed charges,32% of total billed charges,210.16,71,,,percent of total billed charges,71% of total billed charges,210.16,71,,,percent of total billed charges,71% of total billed charges,198.32,67,,,percent of total billed charges,67% of total billed charges,198.32,67,,,percent of total billed charges,67% of total billed charges,210.16,71,,,percent of total billed charges,71% of total billed charges,224.96,76,,,percent of total billed charges,76% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,97.56,32.96,,,percent of total billed charges,32.96% of total billed charges,45.75,105,,,Fee Schedule,pays based on EAPG rates,266.4,90,,,percent of total billed charges,90% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,262.26,88.6,,,percent of total billed charges,88.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,94.72,32,,,percent of total billed charges,32% of total billed charges,236.8,80,,,percent of total billed charges,80% of total billed charges,236.8,80,,,percent of total billed charges,80% of total billed charges,43.57,100,,,Fee Schedule,pays based on EAPG rates,269.36,91,,,percent of total billed charges,91% of total billed charges,96.61,32.64,,,percent of total billed charges,32.64% of total billed charges,94.72,32,,,percent of total billed charges,32% of total billed charges,99.46,33.6,,,percent of total billed charges,33.6% of total billed charges,44.88,103,,,Fee Schedule,pays based on EAPG rates,94.72,32,,,percent of total billed charges,32% of total billed charges,94.72,32,,,percent of total billed charges,32% of total billed charges,272.32,92,,,percent of total billed charges,92% of total billed charges,43.57,272.32,
ST MBS,3200032,CDM,444,RC,92611,HCPCS,Outpatient,,,362,307.7,,293.94,81.2,,,percent of total billed charges,81.2% of total billed charges,118.16,32.64,,,percent of total billed charges,32.64% of total billed charges,267.88,74,,,percent of total billed charges,74% of total billed charges,267.88,74,,,percent of total billed charges,74% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,242.54,67,,,percent of total billed charges,67% of total billed charges,242.54,67,,,percent of total billed charges,67% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,275.12,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,119.32,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,325.8,90,,,percent of total billed charges,90% of total billed charges,325.8,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,320.73,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,289.6,80,,,percent of total billed charges,80% of total billed charges,289.6,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,329.42,91,,,percent of total billed charges,91% of total billed charges,118.16,32.64,,,percent of total billed charges,32.64% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,121.63,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,333.04,92,,,percent of total billed charges,92% of total billed charges,87.85,333.04,
ST ASSMT OF APHASIA/HR,3200062,CDM,440,RC,96105,HCPCS,Outpatient,,,411,349.35,,333.73,81.2,,,percent of total billed charges,81.2% of total billed charges,134.15,32.64,,,percent of total billed charges,32.64% of total billed charges,304.14,74,,,percent of total billed charges,74% of total billed charges,304.14,74,,,percent of total billed charges,74% of total billed charges,131.52,32,,,percent of total billed charges,32% of total billed charges,114.82,103,,,Fee Schedule,pays based on EAPG rates,131.52,32,,,percent of total billed charges,32% of total billed charges,291.81,71,,,percent of total billed charges,71% of total billed charges,291.81,71,,,percent of total billed charges,71% of total billed charges,275.37,67,,,percent of total billed charges,67% of total billed charges,275.37,67,,,percent of total billed charges,67% of total billed charges,291.81,71,,,percent of total billed charges,71% of total billed charges,312.36,76,,,percent of total billed charges,76% of total billed charges,114.82,103,,,Fee Schedule,pays based on EAPG rates,135.47,32.96,,,percent of total billed charges,32.96% of total billed charges,117.05,105,,,Fee Schedule,pays based on EAPG rates,369.9,90,,,percent of total billed charges,90% of total billed charges,369.9,90,,,percent of total billed charges,90% of total billed charges,111.47,100,,,Fee Schedule,pays based on EAPG rates,364.15,88.6,,,percent of total billed charges,88.6% of total billed charges,114.82,103,,,Fee Schedule,pays based on EAPG rates,131.52,32,,,percent of total billed charges,32% of total billed charges,328.8,80,,,percent of total billed charges,80% of total billed charges,328.8,80,,,percent of total billed charges,80% of total billed charges,111.47,100,,,Fee Schedule,pays based on EAPG rates,374.01,91,,,percent of total billed charges,91% of total billed charges,134.15,32.64,,,percent of total billed charges,32.64% of total billed charges,131.52,32,,,percent of total billed charges,32% of total billed charges,138.1,33.6,,,percent of total billed charges,33.6% of total billed charges,114.82,103,,,Fee Schedule,pays based on EAPG rates,131.52,32,,,percent of total billed charges,32% of total billed charges,131.52,32,,,percent of total billed charges,32% of total billed charges,378.12,92,,,percent of total billed charges,92% of total billed charges,111.47,378.12,
ST NEUROBEH TSTG INTERP/REP/HR,3200063,CDM,440,RC,96125,HCPCS,Outpatient,,,393,334.05,,319.12,81.2,,,percent of total billed charges,81.2% of total billed charges,128.28,32.64,,,percent of total billed charges,32.64% of total billed charges,290.82,74,,,percent of total billed charges,74% of total billed charges,290.82,74,,,percent of total billed charges,74% of total billed charges,125.76,32,,,percent of total billed charges,32% of total billed charges,114.82,103,,,Fee Schedule,pays based on EAPG rates,125.76,32,,,percent of total billed charges,32% of total billed charges,279.03,71,,,percent of total billed charges,71% of total billed charges,279.03,71,,,percent of total billed charges,71% of total billed charges,263.31,67,,,percent of total billed charges,67% of total billed charges,263.31,67,,,percent of total billed charges,67% of total billed charges,279.03,71,,,percent of total billed charges,71% of total billed charges,298.68,76,,,percent of total billed charges,76% of total billed charges,114.82,103,,,Fee Schedule,pays based on EAPG rates,129.53,32.96,,,percent of total billed charges,32.96% of total billed charges,117.05,105,,,Fee Schedule,pays based on EAPG rates,353.7,90,,,percent of total billed charges,90% of total billed charges,353.7,90,,,percent of total billed charges,90% of total billed charges,111.47,100,,,Fee Schedule,pays based on EAPG rates,348.2,88.6,,,percent of total billed charges,88.6% of total billed charges,114.82,103,,,Fee Schedule,pays based on EAPG rates,125.76,32,,,percent of total billed charges,32% of total billed charges,314.4,80,,,percent of total billed charges,80% of total billed charges,314.4,80,,,percent of total billed charges,80% of total billed charges,111.47,100,,,Fee Schedule,pays based on EAPG rates,357.63,91,,,percent of total billed charges,91% of total billed charges,128.28,32.64,,,percent of total billed charges,32.64% of total billed charges,125.76,32,,,percent of total billed charges,32% of total billed charges,132.05,33.6,,,percent of total billed charges,33.6% of total billed charges,114.82,103,,,Fee Schedule,pays based on EAPG rates,125.76,32,,,percent of total billed charges,32% of total billed charges,125.76,32,,,percent of total billed charges,32% of total billed charges,361.56,92,,,percent of total billed charges,92% of total billed charges,111.47,361.56,
ST COGN RETRG INITIAL 15 MIN,3200016,CDM,441,RC,97129,HCPCS,Outpatient,,,72,61.2,,58.46,81.2,,,percent of total billed charges,81.2% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,54.72,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,23.73,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,63.79,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,65.52,91,,,percent of total billed charges,91% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,24.19,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,66.24,92,,,percent of total billed charges,92% of total billed charges,23.04,66.24,
ST COGN RETRG ADDTL15 MIN,3200351,CDM,441,RC,97130,HCPCS,Outpatient,,,72,61.2,,58.46,81.2,,,percent of total billed charges,81.2% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,53.28,74,,,percent of total billed charges,74% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,48.24,67,,,percent of total billed charges,67% of total billed charges,51.12,71,,,percent of total billed charges,71% of total billed charges,54.72,76,,,percent of total billed charges,76% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,23.73,32.96,,,percent of total billed charges,32.96% of total billed charges,55.03,105,,,Fee Schedule,pays based on EAPG rates,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,63.79,88.6,,,percent of total billed charges,88.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,57.6,80,,,percent of total billed charges,80% of total billed charges,52.41,100,,,Fee Schedule,pays based on EAPG rates,65.52,91,,,percent of total billed charges,91% of total billed charges,23.5,32.64,,,percent of total billed charges,32.64% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,24.19,33.6,,,percent of total billed charges,33.6% of total billed charges,53.98,103,,,Fee Schedule,pays based on EAPG rates,23.04,32,,,percent of total billed charges,32% of total billed charges,23.04,32,,,percent of total billed charges,32% of total billed charges,66.24,92,,,percent of total billed charges,92% of total billed charges,23.04,66.24,
US GUIDE FOR NEEDLE BIOPSY,400065,CDM,360,RC,76942,HCPCS,Outpatient,,,578,491.3,,469.34,81.2,,,percent of total billed charges,81.2% of total billed charges,188.66,32.64,,,percent of total billed charges,32.64% of total billed charges,427.72,74,,,percent of total billed charges,74% of total billed charges,427.72,74,,,percent of total billed charges,74% of total billed charges,184.96,32,,,percent of total billed charges,32% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,184.96,32,,,percent of total billed charges,32% of total billed charges,410.38,71,,,percent of total billed charges,71% of total billed charges,410.38,71,,,percent of total billed charges,71% of total billed charges,387.26,67,,,percent of total billed charges,67% of total billed charges,387.26,67,,,percent of total billed charges,67% of total billed charges,410.38,71,,,percent of total billed charges,71% of total billed charges,439.28,76,,,percent of total billed charges,76% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,190.51,32.96,,,percent of total billed charges,32.96% of total billed charges,60.29,105,,,Fee Schedule,pays based on EAPG rates,520.2,90,,,percent of total billed charges,90% of total billed charges,520.2,90,,,percent of total billed charges,90% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,512.11,88.6,,,percent of total billed charges,88.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,184.96,32,,,percent of total billed charges,32% of total billed charges,462.4,80,,,percent of total billed charges,80% of total billed charges,462.4,80,,,percent of total billed charges,80% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,525.98,91,,,percent of total billed charges,91% of total billed charges,188.66,32.64,,,percent of total billed charges,32.64% of total billed charges,184.96,32,,,percent of total billed charges,32% of total billed charges,194.21,33.6,,,percent of total billed charges,33.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,184.96,32,,,percent of total billed charges,32% of total billed charges,184.96,32,,,percent of total billed charges,32% of total billed charges,531.76,92,,,percent of total billed charges,92% of total billed charges,57.42,531.76,
PAR PHASE II,700025,CDM,710,RC,,,Outpatient,,,398,338.3,,323.18,81.2,,,percent of total billed charges,81.2% of total billed charges,129.91,32.64,,,percent of total billed charges,32.64% of total billed charges,294.52,74,,,percent of total billed charges,74% of total billed charges,294.52,74,,,percent of total billed charges,74% of total billed charges,127.36,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,127.36,32,,,percent of total billed charges,32% of total billed charges,282.58,71,,,percent of total billed charges,71% of total billed charges,282.58,71,,,percent of total billed charges,71% of total billed charges,266.66,67,,,percent of total billed charges,67% of total billed charges,266.66,67,,,percent of total billed charges,67% of total billed charges,282.58,71,,,percent of total billed charges,71% of total billed charges,302.48,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,131.18,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,358.2,90,,,percent of total billed charges,90% of total billed charges,358.2,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,352.63,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,127.36,32,,,percent of total billed charges,32% of total billed charges,318.4,80,,,percent of total billed charges,80% of total billed charges,318.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,362.18,91,,,percent of total billed charges,91% of total billed charges,129.91,32.64,,,percent of total billed charges,32.64% of total billed charges,127.36,32,,,percent of total billed charges,32% of total billed charges,133.73,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,127.36,32,,,percent of total billed charges,32% of total billed charges,127.36,32,,,percent of total billed charges,32% of total billed charges,366.16,92,,,percent of total billed charges,92% of total billed charges,127.36,366.16,
RECOVERY RM ADDITIONAL 15 MINUTES,600028,CDM,710,RC,,,Outpatient,,,422,358.7,,342.66,81.2,,,percent of total billed charges,81.2% of total billed charges,137.74,32.64,,,percent of total billed charges,32.64% of total billed charges,312.28,74,,,percent of total billed charges,74% of total billed charges,312.28,74,,,percent of total billed charges,74% of total billed charges,135.04,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,135.04,32,,,percent of total billed charges,32% of total billed charges,299.62,71,,,percent of total billed charges,71% of total billed charges,299.62,71,,,percent of total billed charges,71% of total billed charges,282.74,67,,,percent of total billed charges,67% of total billed charges,282.74,67,,,percent of total billed charges,67% of total billed charges,299.62,71,,,percent of total billed charges,71% of total billed charges,320.72,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,139.09,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,379.8,90,,,percent of total billed charges,90% of total billed charges,379.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,373.89,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,135.04,32,,,percent of total billed charges,32% of total billed charges,337.6,80,,,percent of total billed charges,80% of total billed charges,337.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,384.02,91,,,percent of total billed charges,91% of total billed charges,137.74,32.64,,,percent of total billed charges,32.64% of total billed charges,135.04,32,,,percent of total billed charges,32% of total billed charges,141.79,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,135.04,32,,,percent of total billed charges,32% of total billed charges,135.04,32,,,percent of total billed charges,32% of total billed charges,388.24,92,,,percent of total billed charges,92% of total billed charges,135.04,388.24,
OR LEVEL 1 FIRST ADDTL PROCEDURE,400063,CDM,360,RC,,,Outpatient,,,507,430.95,,411.68,81.2,,,percent of total billed charges,81.2% of total billed charges,165.48,32.64,,,percent of total billed charges,32.64% of total billed charges,375.18,74,,,percent of total billed charges,74% of total billed charges,375.18,74,,,percent of total billed charges,74% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,162.24,32,,,percent of total billed charges,32% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,339.69,67,,,percent of total billed charges,67% of total billed charges,339.69,67,,,percent of total billed charges,67% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,385.32,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,167.11,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,456.3,90,,,percent of total billed charges,90% of total billed charges,456.3,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,449.2,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,162.24,32,,,percent of total billed charges,32% of total billed charges,405.6,80,,,percent of total billed charges,80% of total billed charges,405.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,461.37,91,,,percent of total billed charges,91% of total billed charges,165.48,32.64,,,percent of total billed charges,32.64% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,170.35,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,162.24,32,,,percent of total billed charges,32% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,466.44,92,,,percent of total billed charges,92% of total billed charges,162.24,466.44,
OR LEVEL 1 SECOND ADDTL PROCEDURE,400064,CDM,360,RC,,,Outpatient,,,507,430.95,,411.68,81.2,,,percent of total billed charges,81.2% of total billed charges,165.48,32.64,,,percent of total billed charges,32.64% of total billed charges,375.18,74,,,percent of total billed charges,74% of total billed charges,375.18,74,,,percent of total billed charges,74% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,162.24,32,,,percent of total billed charges,32% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,339.69,67,,,percent of total billed charges,67% of total billed charges,339.69,67,,,percent of total billed charges,67% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,385.32,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,167.11,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,456.3,90,,,percent of total billed charges,90% of total billed charges,456.3,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,449.2,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,162.24,32,,,percent of total billed charges,32% of total billed charges,405.6,80,,,percent of total billed charges,80% of total billed charges,405.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,461.37,91,,,percent of total billed charges,91% of total billed charges,165.48,32.64,,,percent of total billed charges,32.64% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,170.35,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,162.24,32,,,percent of total billed charges,32% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,466.44,92,,,percent of total billed charges,92% of total billed charges,162.24,466.44,
OR LEVEL 1 EACH ADDITIONAL 15 MINUTES,400052,CDM,360,RC,,,Outpatient,,,737,626.45,,598.44,81.2,,,percent of total billed charges,81.2% of total billed charges,240.56,32.64,,,percent of total billed charges,32.64% of total billed charges,545.38,74,,,percent of total billed charges,74% of total billed charges,545.38,74,,,percent of total billed charges,74% of total billed charges,235.84,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,235.84,32,,,percent of total billed charges,32% of total billed charges,523.27,71,,,percent of total billed charges,71% of total billed charges,523.27,71,,,percent of total billed charges,71% of total billed charges,493.79,67,,,percent of total billed charges,67% of total billed charges,493.79,67,,,percent of total billed charges,67% of total billed charges,523.27,71,,,percent of total billed charges,71% of total billed charges,560.12,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,242.92,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,663.3,90,,,percent of total billed charges,90% of total billed charges,663.3,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,652.98,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,235.84,32,,,percent of total billed charges,32% of total billed charges,589.6,80,,,percent of total billed charges,80% of total billed charges,589.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,670.67,91,,,percent of total billed charges,91% of total billed charges,240.56,32.64,,,percent of total billed charges,32.64% of total billed charges,235.84,32,,,percent of total billed charges,32% of total billed charges,247.63,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,235.84,32,,,percent of total billed charges,32% of total billed charges,235.84,32,,,percent of total billed charges,32% of total billed charges,678.04,92,,,percent of total billed charges,92% of total billed charges,235.84,678.04,
RECOVERY RM FIRST 1/2 HR,600027,CDM,710,RC,,,Outpatient,,,871,740.35,,707.25,81.2,,,percent of total billed charges,81.2% of total billed charges,284.29,32.64,,,percent of total billed charges,32.64% of total billed charges,644.54,74,,,percent of total billed charges,74% of total billed charges,644.54,74,,,percent of total billed charges,74% of total billed charges,278.72,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,278.72,32,,,percent of total billed charges,32% of total billed charges,618.41,71,,,percent of total billed charges,71% of total billed charges,618.41,71,,,percent of total billed charges,71% of total billed charges,583.57,67,,,percent of total billed charges,67% of total billed charges,583.57,67,,,percent of total billed charges,67% of total billed charges,618.41,71,,,percent of total billed charges,71% of total billed charges,661.96,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,287.08,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,783.9,90,,,percent of total billed charges,90% of total billed charges,783.9,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,771.71,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,278.72,32,,,percent of total billed charges,32% of total billed charges,696.8,80,,,percent of total billed charges,80% of total billed charges,696.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,792.61,91,,,percent of total billed charges,91% of total billed charges,284.29,32.64,,,percent of total billed charges,32.64% of total billed charges,278.72,32,,,percent of total billed charges,32% of total billed charges,292.66,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,278.72,32,,,percent of total billed charges,32% of total billed charges,278.72,32,,,percent of total billed charges,32% of total billed charges,801.32,92,,,percent of total billed charges,92% of total billed charges,278.72,801.32,
OR LEVEL 2 EACH ADDITIONAL 15 MINUTES,400053,CDM,360,RC,,,Outpatient,,,960,816,,779.52,81.2,,,percent of total billed charges,81.2% of total billed charges,313.34,32.64,,,percent of total billed charges,32.64% of total billed charges,710.4,74,,,percent of total billed charges,74% of total billed charges,710.4,74,,,percent of total billed charges,74% of total billed charges,307.2,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,307.2,32,,,percent of total billed charges,32% of total billed charges,681.6,71,,,percent of total billed charges,71% of total billed charges,681.6,71,,,percent of total billed charges,71% of total billed charges,643.2,67,,,percent of total billed charges,67% of total billed charges,643.2,67,,,percent of total billed charges,67% of total billed charges,681.6,71,,,percent of total billed charges,71% of total billed charges,729.6,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,316.42,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,864,90,,,percent of total billed charges,90% of total billed charges,864,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,850.56,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,307.2,32,,,percent of total billed charges,32% of total billed charges,768,80,,,percent of total billed charges,80% of total billed charges,768,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,873.6,91,,,percent of total billed charges,91% of total billed charges,313.34,32.64,,,percent of total billed charges,32.64% of total billed charges,307.2,32,,,percent of total billed charges,32% of total billed charges,322.56,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,307.2,32,,,percent of total billed charges,32% of total billed charges,307.2,32,,,percent of total billed charges,32% of total billed charges,883.2,92,,,percent of total billed charges,92% of total billed charges,307.2,883.2,
OR LEVEL 3 EACH ADDITIONAL 15 MINUTES,400054,CDM,360,RC,,,Outpatient,,,1245,1058.25,,1010.94,81.2,,,percent of total billed charges,81.2% of total billed charges,406.37,32.64,,,percent of total billed charges,32.64% of total billed charges,921.3,74,,,percent of total billed charges,74% of total billed charges,921.3,74,,,percent of total billed charges,74% of total billed charges,398.4,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,398.4,32,,,percent of total billed charges,32% of total billed charges,883.95,71,,,percent of total billed charges,71% of total billed charges,883.95,71,,,percent of total billed charges,71% of total billed charges,834.15,67,,,percent of total billed charges,67% of total billed charges,834.15,67,,,percent of total billed charges,67% of total billed charges,883.95,71,,,percent of total billed charges,71% of total billed charges,946.2,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,410.35,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1120.5,90,,,percent of total billed charges,90% of total billed charges,1120.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1103.07,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,398.4,32,,,percent of total billed charges,32% of total billed charges,996,80,,,percent of total billed charges,80% of total billed charges,996,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1132.95,91,,,percent of total billed charges,91% of total billed charges,406.37,32.64,,,percent of total billed charges,32.64% of total billed charges,398.4,32,,,percent of total billed charges,32% of total billed charges,418.32,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,398.4,32,,,percent of total billed charges,32% of total billed charges,398.4,32,,,percent of total billed charges,32% of total billed charges,1145.4,92,,,percent of total billed charges,92% of total billed charges,398.4,1145.4,
OR LEVEL 4 EACH ADDITIONAL 15 MINUTES,400055,CDM,360,RC,,,Outpatient,,,1571,1335.35,,1275.65,81.2,,,percent of total billed charges,81.2% of total billed charges,512.77,32.64,,,percent of total billed charges,32.64% of total billed charges,1162.54,74,,,percent of total billed charges,74% of total billed charges,1162.54,74,,,percent of total billed charges,74% of total billed charges,502.72,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,502.72,32,,,percent of total billed charges,32% of total billed charges,1115.41,71,,,percent of total billed charges,71% of total billed charges,1115.41,71,,,percent of total billed charges,71% of total billed charges,1052.57,67,,,percent of total billed charges,67% of total billed charges,1052.57,67,,,percent of total billed charges,67% of total billed charges,1115.41,71,,,percent of total billed charges,71% of total billed charges,1193.96,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,517.8,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1413.9,90,,,percent of total billed charges,90% of total billed charges,1413.9,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1391.91,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,502.72,32,,,percent of total billed charges,32% of total billed charges,1256.8,80,,,percent of total billed charges,80% of total billed charges,1256.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1429.61,91,,,percent of total billed charges,91% of total billed charges,512.77,32.64,,,percent of total billed charges,32.64% of total billed charges,502.72,32,,,percent of total billed charges,32% of total billed charges,527.86,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,502.72,32,,,percent of total billed charges,32% of total billed charges,502.72,32,,,percent of total billed charges,32% of total billed charges,1445.32,92,,,percent of total billed charges,92% of total billed charges,502.72,1445.32,
OR LEVEL 5 EACH ADDITIONAL 15 MINUTES,400056,CDM,360,RC,,,Outpatient,,,2043,1736.55,,1658.92,81.2,,,percent of total billed charges,81.2% of total billed charges,666.84,32.64,,,percent of total billed charges,32.64% of total billed charges,1511.82,74,,,percent of total billed charges,74% of total billed charges,1511.82,74,,,percent of total billed charges,74% of total billed charges,653.76,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,653.76,32,,,percent of total billed charges,32% of total billed charges,1450.53,71,,,percent of total billed charges,71% of total billed charges,1450.53,71,,,percent of total billed charges,71% of total billed charges,1368.81,67,,,percent of total billed charges,67% of total billed charges,1368.81,67,,,percent of total billed charges,67% of total billed charges,1450.53,71,,,percent of total billed charges,71% of total billed charges,1552.68,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,673.37,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1838.7,90,,,percent of total billed charges,90% of total billed charges,1838.7,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1810.1,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,653.76,32,,,percent of total billed charges,32% of total billed charges,1634.4,80,,,percent of total billed charges,80% of total billed charges,1634.4,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1859.13,91,,,percent of total billed charges,91% of total billed charges,666.84,32.64,,,percent of total billed charges,32.64% of total billed charges,653.76,32,,,percent of total billed charges,32% of total billed charges,686.45,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,653.76,32,,,percent of total billed charges,32% of total billed charges,653.76,32,,,percent of total billed charges,32% of total billed charges,1879.56,92,,,percent of total billed charges,92% of total billed charges,653.76,1879.56,
OR LEVEL 1,400047,CDM,360,RC,,,Outpatient,,,2094,1779.9,,1700.33,81.2,,,percent of total billed charges,81.2% of total billed charges,683.48,32.64,,,percent of total billed charges,32.64% of total billed charges,1549.56,74,,,percent of total billed charges,74% of total billed charges,1549.56,74,,,percent of total billed charges,74% of total billed charges,670.08,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,670.08,32,,,percent of total billed charges,32% of total billed charges,1486.74,71,,,percent of total billed charges,71% of total billed charges,1486.74,71,,,percent of total billed charges,71% of total billed charges,1402.98,67,,,percent of total billed charges,67% of total billed charges,1402.98,67,,,percent of total billed charges,67% of total billed charges,1486.74,71,,,percent of total billed charges,71% of total billed charges,1591.44,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,690.18,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,1884.6,90,,,percent of total billed charges,90% of total billed charges,1884.6,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,1855.28,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,670.08,32,,,percent of total billed charges,32% of total billed charges,1675.2,80,,,percent of total billed charges,80% of total billed charges,1675.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,1905.54,91,,,percent of total billed charges,91% of total billed charges,683.48,32.64,,,percent of total billed charges,32.64% of total billed charges,670.08,32,,,percent of total billed charges,32% of total billed charges,703.58,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,670.08,32,,,percent of total billed charges,32% of total billed charges,670.08,32,,,percent of total billed charges,32% of total billed charges,1926.48,92,,,percent of total billed charges,92% of total billed charges,670.08,1926.48,
OR LEVEL 6 EACH ADDITIONAL 15 MINUTES,400067,CDM,360,RC,,,Outpatient,,,2576,2189.6,,2091.71,81.2,,,percent of total billed charges,81.2% of total billed charges,840.81,32.64,,,percent of total billed charges,32.64% of total billed charges,1906.24,74,,,percent of total billed charges,74% of total billed charges,1906.24,74,,,percent of total billed charges,74% of total billed charges,824.32,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,824.32,32,,,percent of total billed charges,32% of total billed charges,1828.96,71,,,percent of total billed charges,71% of total billed charges,1828.96,71,,,percent of total billed charges,71% of total billed charges,1725.92,67,,,percent of total billed charges,67% of total billed charges,1725.92,67,,,percent of total billed charges,67% of total billed charges,1828.96,71,,,percent of total billed charges,71% of total billed charges,1957.76,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,849.05,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,2318.4,90,,,percent of total billed charges,90% of total billed charges,2318.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,2282.34,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,824.32,32,,,percent of total billed charges,32% of total billed charges,2060.8,80,,,percent of total billed charges,80% of total billed charges,2060.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,2344.16,91,,,percent of total billed charges,91% of total billed charges,840.81,32.64,,,percent of total billed charges,32.64% of total billed charges,824.32,32,,,percent of total billed charges,32% of total billed charges,865.54,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,824.32,32,,,percent of total billed charges,32% of total billed charges,824.32,32,,,percent of total billed charges,32% of total billed charges,2369.92,92,,,percent of total billed charges,92% of total billed charges,824.32,2369.92,
OR LEVEL 2,400048,CDM,360,RC,,,Outpatient,,,3325,2826.25,,2699.9,81.2,,,percent of total billed charges,81.2% of total billed charges,1085.28,32.64,,,percent of total billed charges,32.64% of total billed charges,2460.5,74,,,percent of total billed charges,74% of total billed charges,2460.5,74,,,percent of total billed charges,74% of total billed charges,1064,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,1064,32,,,percent of total billed charges,32% of total billed charges,2360.75,71,,,percent of total billed charges,71% of total billed charges,2360.75,71,,,percent of total billed charges,71% of total billed charges,2227.75,67,,,percent of total billed charges,67% of total billed charges,2227.75,67,,,percent of total billed charges,67% of total billed charges,2360.75,71,,,percent of total billed charges,71% of total billed charges,2527,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,1095.92,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,2992.5,90,,,percent of total billed charges,90% of total billed charges,2992.5,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,2945.95,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,1064,32,,,percent of total billed charges,32% of total billed charges,2660,80,,,percent of total billed charges,80% of total billed charges,2660,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,3025.75,91,,,percent of total billed charges,91% of total billed charges,1085.28,32.64,,,percent of total billed charges,32.64% of total billed charges,1064,32,,,percent of total billed charges,32% of total billed charges,1117.2,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,1064,32,,,percent of total billed charges,32% of total billed charges,1064,32,,,percent of total billed charges,32% of total billed charges,3059,92,,,percent of total billed charges,92% of total billed charges,1064,3059,
OR LEVEL 3,400049,CDM,360,RC,,,Outpatient,,,4416,3753.6,,3585.79,81.2,,,percent of total billed charges,81.2% of total billed charges,1441.38,32.64,,,percent of total billed charges,32.64% of total billed charges,3267.84,74,,,percent of total billed charges,74% of total billed charges,3267.84,74,,,percent of total billed charges,74% of total billed charges,1413.12,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,1413.12,32,,,percent of total billed charges,32% of total billed charges,3135.36,71,,,percent of total billed charges,71% of total billed charges,3135.36,71,,,percent of total billed charges,71% of total billed charges,2958.72,67,,,percent of total billed charges,67% of total billed charges,2958.72,67,,,percent of total billed charges,67% of total billed charges,3135.36,71,,,percent of total billed charges,71% of total billed charges,3356.16,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,1455.51,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,3974.4,90,,,percent of total billed charges,90% of total billed charges,3974.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,3912.58,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,1413.12,32,,,percent of total billed charges,32% of total billed charges,3532.8,80,,,percent of total billed charges,80% of total billed charges,3532.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,4018.56,91,,,percent of total billed charges,91% of total billed charges,1441.38,32.64,,,percent of total billed charges,32.64% of total billed charges,1413.12,32,,,percent of total billed charges,32% of total billed charges,1483.78,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,1413.12,32,,,percent of total billed charges,32% of total billed charges,1413.12,32,,,percent of total billed charges,32% of total billed charges,4062.72,92,,,percent of total billed charges,92% of total billed charges,1413.12,4062.72,
OR LEVEL 4,400050,CDM,360,RC,,,Outpatient,,,5391,4582.35,,4377.49,81.2,,,percent of total billed charges,81.2% of total billed charges,1759.62,32.64,,,percent of total billed charges,32.64% of total billed charges,3989.34,74,,,percent of total billed charges,74% of total billed charges,3989.34,74,,,percent of total billed charges,74% of total billed charges,1725.12,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,1725.12,32,,,percent of total billed charges,32% of total billed charges,3827.61,71,,,percent of total billed charges,71% of total billed charges,3827.61,71,,,percent of total billed charges,71% of total billed charges,3611.97,67,,,percent of total billed charges,67% of total billed charges,3611.97,67,,,percent of total billed charges,67% of total billed charges,3827.61,71,,,percent of total billed charges,71% of total billed charges,4097.16,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,1776.87,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,4851.9,90,,,percent of total billed charges,90% of total billed charges,4851.9,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,4776.43,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,1725.12,32,,,percent of total billed charges,32% of total billed charges,4312.8,80,,,percent of total billed charges,80% of total billed charges,4312.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,4905.81,91,,,percent of total billed charges,91% of total billed charges,1759.62,32.64,,,percent of total billed charges,32.64% of total billed charges,1725.12,32,,,percent of total billed charges,32% of total billed charges,1811.38,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,1725.12,32,,,percent of total billed charges,32% of total billed charges,1725.12,32,,,percent of total billed charges,32% of total billed charges,4959.72,92,,,percent of total billed charges,92% of total billed charges,1725.12,4959.72,
OR LEVEL 5,400051,CDM,360,RC,,,Outpatient,,,6719,5711.15,,5455.83,81.2,,,percent of total billed charges,81.2% of total billed charges,2193.08,32.64,,,percent of total billed charges,32.64% of total billed charges,4972.06,74,,,percent of total billed charges,74% of total billed charges,4972.06,74,,,percent of total billed charges,74% of total billed charges,2150.08,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,2150.08,32,,,percent of total billed charges,32% of total billed charges,4770.49,71,,,percent of total billed charges,71% of total billed charges,4770.49,71,,,percent of total billed charges,71% of total billed charges,4501.73,67,,,percent of total billed charges,67% of total billed charges,4501.73,67,,,percent of total billed charges,67% of total billed charges,4770.49,71,,,percent of total billed charges,71% of total billed charges,5106.44,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,2214.58,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,6047.1,90,,,percent of total billed charges,90% of total billed charges,6047.1,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,5953.03,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,2150.08,32,,,percent of total billed charges,32% of total billed charges,5375.2,80,,,percent of total billed charges,80% of total billed charges,5375.2,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,6114.29,91,,,percent of total billed charges,91% of total billed charges,2193.08,32.64,,,percent of total billed charges,32.64% of total billed charges,2150.08,32,,,percent of total billed charges,32% of total billed charges,2257.58,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,2150.08,32,,,percent of total billed charges,32% of total billed charges,2150.08,32,,,percent of total billed charges,32% of total billed charges,6181.48,92,,,percent of total billed charges,92% of total billed charges,2150.08,6181.48,
OR LEVEL 6,400066,CDM,360,RC,,,Outpatient,,,7886,6703.1,,6403.43,81.2,,,percent of total billed charges,81.2% of total billed charges,2573.99,32.64,,,percent of total billed charges,32.64% of total billed charges,5835.64,74,,,percent of total billed charges,74% of total billed charges,5835.64,74,,,percent of total billed charges,74% of total billed charges,2523.52,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,2523.52,32,,,percent of total billed charges,32% of total billed charges,5599.06,71,,,percent of total billed charges,71% of total billed charges,5599.06,71,,,percent of total billed charges,71% of total billed charges,5283.62,67,,,percent of total billed charges,67% of total billed charges,5283.62,67,,,percent of total billed charges,67% of total billed charges,5599.06,71,,,percent of total billed charges,71% of total billed charges,5993.36,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,2599.23,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,7097.4,90,,,percent of total billed charges,90% of total billed charges,7097.4,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,6987,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,2523.52,32,,,percent of total billed charges,32% of total billed charges,6308.8,80,,,percent of total billed charges,80% of total billed charges,6308.8,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,7176.26,91,,,percent of total billed charges,91% of total billed charges,2573.99,32.64,,,percent of total billed charges,32.64% of total billed charges,2523.52,32,,,percent of total billed charges,32% of total billed charges,2649.7,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,2523.52,32,,,percent of total billed charges,32% of total billed charges,2523.52,32,,,percent of total billed charges,32% of total billed charges,7255.12,92,,,percent of total billed charges,92% of total billed charges,2523.52,7255.12,
US THYROID FNA BIOPSY,4400085,CDM,402,RC,10005,HCPCS,Outpatient,,,2596,2206.6,,2107.95,81.2,,,percent of total billed charges,81.2% of total billed charges,847.33,32.64,,,percent of total billed charges,32.64% of total billed charges,1921.04,74,,,percent of total billed charges,74% of total billed charges,1921.04,74,,,percent of total billed charges,74% of total billed charges,830.72,32,,,percent of total billed charges,32% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,830.72,32,,,percent of total billed charges,32% of total billed charges,1843.16,71,,,percent of total billed charges,71% of total billed charges,1843.16,71,,,percent of total billed charges,71% of total billed charges,1739.32,67,,,percent of total billed charges,67% of total billed charges,1739.32,67,,,percent of total billed charges,67% of total billed charges,1843.16,71,,,percent of total billed charges,71% of total billed charges,1972.96,76,,,percent of total billed charges,76% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,855.64,32.96,,,percent of total billed charges,32.96% of total billed charges,248.83,105,,,Fee Schedule,pays based on EAPG rates,2336.4,90,,,percent of total billed charges,90% of total billed charges,2336.4,90,,,percent of total billed charges,90% of total billed charges,236.98,100,,,Fee Schedule,pays based on EAPG rates,2300.06,88.6,,,percent of total billed charges,88.6% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,830.72,32,,,percent of total billed charges,32% of total billed charges,2076.8,80,,,percent of total billed charges,80% of total billed charges,2076.8,80,,,percent of total billed charges,80% of total billed charges,236.98,100,,,Fee Schedule,pays based on EAPG rates,2362.36,91,,,percent of total billed charges,91% of total billed charges,847.33,32.64,,,percent of total billed charges,32.64% of total billed charges,830.72,32,,,percent of total billed charges,32% of total billed charges,872.26,33.6,,,percent of total billed charges,33.6% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,830.72,32,,,percent of total billed charges,32% of total billed charges,830.72,32,,,percent of total billed charges,32% of total billed charges,2388.32,92,,,percent of total billed charges,92% of total billed charges,236.98,2388.32,
US THYROID FNA BIOPSY ADDTL LESION,4400097,CDM,402,RC,10006,HCPCS,Outpatient,,,1298,1103.3,,1053.98,81.2,,,percent of total billed charges,81.2% of total billed charges,423.67,32.64,,,percent of total billed charges,32.64% of total billed charges,960.52,74,,,percent of total billed charges,74% of total billed charges,960.52,74,,,percent of total billed charges,74% of total billed charges,415.36,32,,,percent of total billed charges,32% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,415.36,32,,,percent of total billed charges,32% of total billed charges,921.58,71,,,percent of total billed charges,71% of total billed charges,921.58,71,,,percent of total billed charges,71% of total billed charges,869.66,67,,,percent of total billed charges,67% of total billed charges,869.66,67,,,percent of total billed charges,67% of total billed charges,921.58,71,,,percent of total billed charges,71% of total billed charges,986.48,76,,,percent of total billed charges,76% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,427.82,32.96,,,percent of total billed charges,32.96% of total billed charges,248.83,105,,,Fee Schedule,pays based on EAPG rates,1168.2,90,,,percent of total billed charges,90% of total billed charges,1168.2,90,,,percent of total billed charges,90% of total billed charges,236.98,100,,,Fee Schedule,pays based on EAPG rates,1150.03,88.6,,,percent of total billed charges,88.6% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,415.36,32,,,percent of total billed charges,32% of total billed charges,1038.4,80,,,percent of total billed charges,80% of total billed charges,1038.4,80,,,percent of total billed charges,80% of total billed charges,236.98,100,,,Fee Schedule,pays based on EAPG rates,1181.18,91,,,percent of total billed charges,91% of total billed charges,423.67,32.64,,,percent of total billed charges,32.64% of total billed charges,415.36,32,,,percent of total billed charges,32% of total billed charges,436.13,33.6,,,percent of total billed charges,33.6% of total billed charges,244.09,103,,,Fee Schedule,pays based on EAPG rates,415.36,32,,,percent of total billed charges,32% of total billed charges,415.36,32,,,percent of total billed charges,32% of total billed charges,1194.16,92,,,percent of total billed charges,92% of total billed charges,236.98,1194.16,
US BREAST BX W/ GUIDE LT,4400087,CDM,402,RC,19083,HCPCS,Outpatient,,,4633,3938.05,,3762,81.2,,,percent of total billed charges,81.2% of total billed charges,1512.21,32.64,,,percent of total billed charges,32.64% of total billed charges,3428.42,74,,,percent of total billed charges,74% of total billed charges,3428.42,74,,,percent of total billed charges,74% of total billed charges,1482.56,32,,,percent of total billed charges,32% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,1482.56,32,,,percent of total billed charges,32% of total billed charges,3289.43,71,,,percent of total billed charges,71% of total billed charges,3289.43,71,,,percent of total billed charges,71% of total billed charges,3104.11,67,,,percent of total billed charges,67% of total billed charges,3104.11,67,,,percent of total billed charges,67% of total billed charges,3289.43,71,,,percent of total billed charges,71% of total billed charges,3521.08,76,,,percent of total billed charges,76% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,1527.04,32.96,,,percent of total billed charges,32.96% of total billed charges,667.4,105,,,Fee Schedule,pays based on EAPG rates,4169.7,90,,,percent of total billed charges,90% of total billed charges,4169.7,90,,,percent of total billed charges,90% of total billed charges,635.62,100,,,Fee Schedule,pays based on EAPG rates,4104.84,88.6,,,percent of total billed charges,88.6% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,1482.56,32,,,percent of total billed charges,32% of total billed charges,3706.4,80,,,percent of total billed charges,80% of total billed charges,3706.4,80,,,percent of total billed charges,80% of total billed charges,635.62,100,,,Fee Schedule,pays based on EAPG rates,4216.03,91,,,percent of total billed charges,91% of total billed charges,1512.21,32.64,,,percent of total billed charges,32.64% of total billed charges,1482.56,32,,,percent of total billed charges,32% of total billed charges,1556.69,33.6,,,percent of total billed charges,33.6% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,1482.56,32,,,percent of total billed charges,32% of total billed charges,1482.56,32,,,percent of total billed charges,32% of total billed charges,4262.36,92,,,percent of total billed charges,92% of total billed charges,635.62,4262.36,
US BREAST BX W/ GUIDE RT,4400086,CDM,402,RC,19083,HCPCS,Outpatient,,,4633,3938.05,,3762,81.2,,,percent of total billed charges,81.2% of total billed charges,1512.21,32.64,,,percent of total billed charges,32.64% of total billed charges,3428.42,74,,,percent of total billed charges,74% of total billed charges,3428.42,74,,,percent of total billed charges,74% of total billed charges,1482.56,32,,,percent of total billed charges,32% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,1482.56,32,,,percent of total billed charges,32% of total billed charges,3289.43,71,,,percent of total billed charges,71% of total billed charges,3289.43,71,,,percent of total billed charges,71% of total billed charges,3104.11,67,,,percent of total billed charges,67% of total billed charges,3104.11,67,,,percent of total billed charges,67% of total billed charges,3289.43,71,,,percent of total billed charges,71% of total billed charges,3521.08,76,,,percent of total billed charges,76% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,1527.04,32.96,,,percent of total billed charges,32.96% of total billed charges,667.4,105,,,Fee Schedule,pays based on EAPG rates,4169.7,90,,,percent of total billed charges,90% of total billed charges,4169.7,90,,,percent of total billed charges,90% of total billed charges,635.62,100,,,Fee Schedule,pays based on EAPG rates,4104.84,88.6,,,percent of total billed charges,88.6% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,1482.56,32,,,percent of total billed charges,32% of total billed charges,3706.4,80,,,percent of total billed charges,80% of total billed charges,3706.4,80,,,percent of total billed charges,80% of total billed charges,635.62,100,,,Fee Schedule,pays based on EAPG rates,4216.03,91,,,percent of total billed charges,91% of total billed charges,1512.21,32.64,,,percent of total billed charges,32.64% of total billed charges,1482.56,32,,,percent of total billed charges,32% of total billed charges,1556.69,33.6,,,percent of total billed charges,33.6% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,1482.56,32,,,percent of total billed charges,32% of total billed charges,1482.56,32,,,percent of total billed charges,32% of total billed charges,4262.36,92,,,percent of total billed charges,92% of total billed charges,635.62,4262.36,
US BREAST BX W/ GUIDE BIL,4400375,CDM,402,RC,19083,HCPCS,Outpatient,,,6949,5906.65,,5642.59,81.2,,,percent of total billed charges,81.2% of total billed charges,2268.15,32.64,,,percent of total billed charges,32.64% of total billed charges,5142.26,74,,,percent of total billed charges,74% of total billed charges,5142.26,74,,,percent of total billed charges,74% of total billed charges,2223.68,32,,,percent of total billed charges,32% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,2223.68,32,,,percent of total billed charges,32% of total billed charges,4933.79,71,,,percent of total billed charges,71% of total billed charges,4933.79,71,,,percent of total billed charges,71% of total billed charges,4655.83,67,,,percent of total billed charges,67% of total billed charges,4655.83,67,,,percent of total billed charges,67% of total billed charges,4933.79,71,,,percent of total billed charges,71% of total billed charges,5281.24,76,,,percent of total billed charges,76% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,2290.39,32.96,,,percent of total billed charges,32.96% of total billed charges,667.4,105,,,Fee Schedule,pays based on EAPG rates,6254.1,90,,,percent of total billed charges,90% of total billed charges,6254.1,90,,,percent of total billed charges,90% of total billed charges,635.62,100,,,Fee Schedule,pays based on EAPG rates,6156.81,88.6,,,percent of total billed charges,88.6% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,2223.68,32,,,percent of total billed charges,32% of total billed charges,5559.2,80,,,percent of total billed charges,80% of total billed charges,5559.2,80,,,percent of total billed charges,80% of total billed charges,635.62,100,,,Fee Schedule,pays based on EAPG rates,6323.59,91,,,percent of total billed charges,91% of total billed charges,2268.15,32.64,,,percent of total billed charges,32.64% of total billed charges,2223.68,32,,,percent of total billed charges,32% of total billed charges,2334.86,33.6,,,percent of total billed charges,33.6% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,2223.68,32,,,percent of total billed charges,32% of total billed charges,2223.68,32,,,percent of total billed charges,32% of total billed charges,6393.08,92,,,percent of total billed charges,92% of total billed charges,635.62,6393.08,
US BREAST EA ADDTL LESION,4400373,CDM,402,RC,19084,HCPCS,Outpatient,,,2316,1968.6,,1880.59,81.2,,,percent of total billed charges,81.2% of total billed charges,755.94,32.64,,,percent of total billed charges,32.64% of total billed charges,1713.84,74,,,percent of total billed charges,74% of total billed charges,1713.84,74,,,percent of total billed charges,74% of total billed charges,741.12,32,,,percent of total billed charges,32% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,741.12,32,,,percent of total billed charges,32% of total billed charges,1644.36,71,,,percent of total billed charges,71% of total billed charges,1644.36,71,,,percent of total billed charges,71% of total billed charges,1551.72,67,,,percent of total billed charges,67% of total billed charges,1551.72,67,,,percent of total billed charges,67% of total billed charges,1644.36,71,,,percent of total billed charges,71% of total billed charges,1760.16,76,,,percent of total billed charges,76% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,763.35,32.96,,,percent of total billed charges,32.96% of total billed charges,667.4,105,,,Fee Schedule,pays based on EAPG rates,2084.4,90,,,percent of total billed charges,90% of total billed charges,2084.4,90,,,percent of total billed charges,90% of total billed charges,635.62,100,,,Fee Schedule,pays based on EAPG rates,2051.98,88.6,,,percent of total billed charges,88.6% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,741.12,32,,,percent of total billed charges,32% of total billed charges,1852.8,80,,,percent of total billed charges,80% of total billed charges,1852.8,80,,,percent of total billed charges,80% of total billed charges,635.62,100,,,Fee Schedule,pays based on EAPG rates,2107.56,91,,,percent of total billed charges,91% of total billed charges,755.94,32.64,,,percent of total billed charges,32.64% of total billed charges,741.12,32,,,percent of total billed charges,32% of total billed charges,778.18,33.6,,,percent of total billed charges,33.6% of total billed charges,654.69,103,,,Fee Schedule,pays based on EAPG rates,741.12,32,,,percent of total billed charges,32% of total billed charges,741.12,32,,,percent of total billed charges,32% of total billed charges,2130.72,92,,,percent of total billed charges,92% of total billed charges,635.62,2130.72,
US NEEDLE LOC BREAST LT,4400046,CDM,360,RC,19285,HCPCS,Outpatient,,,512,435.2,,415.74,81.2,,,percent of total billed charges,81.2% of total billed charges,167.12,32.64,,,percent of total billed charges,32.64% of total billed charges,378.88,74,,,percent of total billed charges,74% of total billed charges,378.88,74,,,percent of total billed charges,74% of total billed charges,163.84,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,163.84,32,,,percent of total billed charges,32% of total billed charges,363.52,71,,,percent of total billed charges,71% of total billed charges,363.52,71,,,percent of total billed charges,71% of total billed charges,343.04,67,,,percent of total billed charges,67% of total billed charges,343.04,67,,,percent of total billed charges,67% of total billed charges,363.52,71,,,percent of total billed charges,71% of total billed charges,389.12,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,168.76,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,460.8,90,,,percent of total billed charges,90% of total billed charges,460.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,453.63,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,163.84,32,,,percent of total billed charges,32% of total billed charges,409.6,80,,,percent of total billed charges,80% of total billed charges,409.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,465.92,91,,,percent of total billed charges,91% of total billed charges,167.12,32.64,,,percent of total billed charges,32.64% of total billed charges,163.84,32,,,percent of total billed charges,32% of total billed charges,172.03,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,163.84,32,,,percent of total billed charges,32% of total billed charges,163.84,32,,,percent of total billed charges,32% of total billed charges,471.04,92,,,percent of total billed charges,92% of total billed charges,163.84,471.04,
US NEEDLE LOC BREAST RT,4400369,CDM,360,RC,19285,HCPCS,Outpatient,,,512,435.2,,415.74,81.2,,,percent of total billed charges,81.2% of total billed charges,167.12,32.64,,,percent of total billed charges,32.64% of total billed charges,378.88,74,,,percent of total billed charges,74% of total billed charges,378.88,74,,,percent of total billed charges,74% of total billed charges,163.84,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,163.84,32,,,percent of total billed charges,32% of total billed charges,363.52,71,,,percent of total billed charges,71% of total billed charges,363.52,71,,,percent of total billed charges,71% of total billed charges,343.04,67,,,percent of total billed charges,67% of total billed charges,343.04,67,,,percent of total billed charges,67% of total billed charges,363.52,71,,,percent of total billed charges,71% of total billed charges,389.12,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,168.76,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,460.8,90,,,percent of total billed charges,90% of total billed charges,460.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,453.63,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,163.84,32,,,percent of total billed charges,32% of total billed charges,409.6,80,,,percent of total billed charges,80% of total billed charges,409.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,465.92,91,,,percent of total billed charges,91% of total billed charges,167.12,32.64,,,percent of total billed charges,32.64% of total billed charges,163.84,32,,,percent of total billed charges,32% of total billed charges,172.03,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,163.84,32,,,percent of total billed charges,32% of total billed charges,163.84,32,,,percent of total billed charges,32% of total billed charges,471.04,92,,,percent of total billed charges,92% of total billed charges,163.84,471.04,
US NEEDLE LOC BREAST BILATERAL,4400080,CDM,360,RC,19285,HCPCS,Outpatient,,,767,651.95,,622.8,81.2,,,percent of total billed charges,81.2% of total billed charges,250.35,32.64,,,percent of total billed charges,32.64% of total billed charges,567.58,74,,,percent of total billed charges,74% of total billed charges,567.58,74,,,percent of total billed charges,74% of total billed charges,245.44,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,245.44,32,,,percent of total billed charges,32% of total billed charges,544.57,71,,,percent of total billed charges,71% of total billed charges,544.57,71,,,percent of total billed charges,71% of total billed charges,513.89,67,,,percent of total billed charges,67% of total billed charges,513.89,67,,,percent of total billed charges,67% of total billed charges,544.57,71,,,percent of total billed charges,71% of total billed charges,582.92,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,252.8,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,690.3,90,,,percent of total billed charges,90% of total billed charges,690.3,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,679.56,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,245.44,32,,,percent of total billed charges,32% of total billed charges,613.6,80,,,percent of total billed charges,80% of total billed charges,613.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,697.97,91,,,percent of total billed charges,91% of total billed charges,250.35,32.64,,,percent of total billed charges,32.64% of total billed charges,245.44,32,,,percent of total billed charges,32% of total billed charges,257.71,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,245.44,32,,,percent of total billed charges,32% of total billed charges,245.44,32,,,percent of total billed charges,32% of total billed charges,705.64,92,,,percent of total billed charges,92% of total billed charges,245.44,705.64,
US NEEDLE LOC ADDITIONAL LESION,4400079,CDM,360,RC,19286,HCPCS,Outpatient,,,512,435.2,,415.74,81.2,,,percent of total billed charges,81.2% of total billed charges,167.12,32.64,,,percent of total billed charges,32.64% of total billed charges,378.88,74,,,percent of total billed charges,74% of total billed charges,378.88,74,,,percent of total billed charges,74% of total billed charges,163.84,32,,,percent of total billed charges,32% of total billed charges,,,,,Other,Not Separately reimbursable,163.84,32,,,percent of total billed charges,32% of total billed charges,363.52,71,,,percent of total billed charges,71% of total billed charges,363.52,71,,,percent of total billed charges,71% of total billed charges,343.04,67,,,percent of total billed charges,67% of total billed charges,343.04,67,,,percent of total billed charges,67% of total billed charges,363.52,71,,,percent of total billed charges,71% of total billed charges,389.12,76,,,percent of total billed charges,76% of total billed charges,,,,,Other,Not Separately reimbursable,168.76,32.96,,,percent of total billed charges,32.96% of total billed charges,,,,,Other,Not Separately reimbursable,460.8,90,,,percent of total billed charges,90% of total billed charges,460.8,90,,,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,453.63,88.6,,,percent of total billed charges,88.6% of total billed charges,,,,,Other,Not Separately reimbursable,163.84,32,,,percent of total billed charges,32% of total billed charges,409.6,80,,,percent of total billed charges,80% of total billed charges,409.6,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,465.92,91,,,percent of total billed charges,91% of total billed charges,167.12,32.64,,,percent of total billed charges,32.64% of total billed charges,163.84,32,,,percent of total billed charges,32% of total billed charges,172.03,33.6,,,percent of total billed charges,33.6% of total billed charges,,,,,Other,Not Separately reimbursable,163.84,32,,,percent of total billed charges,32% of total billed charges,163.84,32,,,percent of total billed charges,32% of total billed charges,471.04,92,,,percent of total billed charges,92% of total billed charges,163.84,471.04,
US BX SOFT TISSUE ABD,4400106,CDM,320,RC,22999,HCPCS,Outpatient,,,953,810.05,,773.84,81.2,,,percent of total billed charges,81.2% of total billed charges,311.06,32.64,,,percent of total billed charges,32.64% of total billed charges,705.22,74,,,percent of total billed charges,74% of total billed charges,705.22,74,,,percent of total billed charges,74% of total billed charges,304.96,32,,,percent of total billed charges,32% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,304.96,32,,,percent of total billed charges,32% of total billed charges,676.63,71,,,percent of total billed charges,71% of total billed charges,676.63,71,,,percent of total billed charges,71% of total billed charges,638.51,67,,,percent of total billed charges,67% of total billed charges,638.51,67,,,percent of total billed charges,67% of total billed charges,676.63,71,,,percent of total billed charges,71% of total billed charges,724.28,76,,,percent of total billed charges,76% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,314.11,32.96,,,percent of total billed charges,32.96% of total billed charges,190.88,105,,,Fee Schedule,pays based on EAPG rates,857.7,90,,,percent of total billed charges,90% of total billed charges,857.7,90,,,percent of total billed charges,90% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,844.36,88.6,,,percent of total billed charges,88.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,304.96,32,,,percent of total billed charges,32% of total billed charges,762.4,80,,,percent of total billed charges,80% of total billed charges,762.4,80,,,percent of total billed charges,80% of total billed charges,181.79,100,,,Fee Schedule,pays based on EAPG rates,867.23,91,,,percent of total billed charges,91% of total billed charges,311.06,32.64,,,percent of total billed charges,32.64% of total billed charges,304.96,32,,,percent of total billed charges,32% of total billed charges,320.21,33.6,,,percent of total billed charges,33.6% of total billed charges,187.25,103,,,Fee Schedule,pays based on EAPG rates,304.96,32,,,percent of total billed charges,32% of total billed charges,304.96,32,,,percent of total billed charges,32% of total billed charges,876.76,92,,,percent of total billed charges,92% of total billed charges,181.79,876.76,
US THORACENTESIS W/ IMAGE GUIDE,4400093,CDM,402,RC,32555,HCPCS,Outpatient,,,2779,2362.15,,2256.55,81.2,,,percent of total billed charges,81.2% of total billed charges,907.07,32.64,,,percent of total billed charges,32.64% of total billed charges,2056.46,74,,,percent of total billed charges,74% of total billed charges,2056.46,74,,,percent of total billed charges,74% of total billed charges,889.28,32,,,percent of total billed charges,32% of total billed charges,482.58,103,,,Fee Schedule,pays based on EAPG rates,889.28,32,,,percent of total billed charges,32% of total billed charges,1973.09,71,,,percent of total billed charges,71% of total billed charges,1973.09,71,,,percent of total billed charges,71% of total billed charges,1861.93,67,,,percent of total billed charges,67% of total billed charges,1861.93,67,,,percent of total billed charges,67% of total billed charges,1973.09,71,,,percent of total billed charges,71% of total billed charges,2112.04,76,,,percent of total billed charges,76% of total billed charges,482.58,103,,,Fee Schedule,pays based on EAPG rates,915.96,32.96,,,percent of total billed charges,32.96% of total billed charges,491.95,105,,,Fee Schedule,pays based on EAPG rates,2501.1,90,,,percent of total billed charges,90% of total billed charges,2501.1,90,,,percent of total billed charges,90% of total billed charges,468.52,100,,,Fee Schedule,pays based on EAPG rates,2462.19,88.6,,,percent of total billed charges,88.6% of total billed charges,482.58,103,,,Fee Schedule,pays based on EAPG rates,889.28,32,,,percent of total billed charges,32% of total billed charges,2223.2,80,,,percent of total billed charges,80% of total billed charges,2223.2,80,,,percent of total billed charges,80% of total billed charges,468.52,100,,,Fee Schedule,pays based on EAPG rates,2528.89,91,,,percent of total billed charges,91% of total billed charges,907.07,32.64,,,percent of total billed charges,32.64% of total billed charges,889.28,32,,,percent of total billed charges,32% of total billed charges,933.74,33.6,,,percent of total billed charges,33.6% of total billed charges,482.58,103,,,Fee Schedule,pays based on EAPG rates,889.28,32,,,percent of total billed charges,32% of total billed charges,889.28,32,,,percent of total billed charges,32% of total billed charges,2556.68,92,,,percent of total billed charges,92% of total billed charges,468.52,2556.68,
US BX AXILLARY LT,4400104,CDM,402,RC,38505,HCPCS,Outpatient,,,6161,5236.85,,5002.73,81.2,,,percent of total billed charges,81.2% of total billed charges,2010.95,32.64,,,percent of total billed charges,32.64% of total billed charges,4559.14,74,,,percent of total billed charges,74% of total billed charges,4559.14,74,,,percent of total billed charges,74% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4127.87,67,,,percent of total billed charges,67% of total billed charges,4127.87,67,,,percent of total billed charges,67% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4682.36,76,,,percent of total billed charges,76% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,2030.67,32.96,,,percent of total billed charges,32.96% of total billed charges,685.99,105,,,Fee Schedule,pays based on EAPG rates,5544.9,90,,,percent of total billed charges,90% of total billed charges,5544.9,90,,,percent of total billed charges,90% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,5458.65,88.6,,,percent of total billed charges,88.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,4928.8,80,,,percent of total billed charges,80% of total billed charges,4928.8,80,,,percent of total billed charges,80% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,5606.51,91,,,percent of total billed charges,91% of total billed charges,2010.95,32.64,,,percent of total billed charges,32.64% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,2070.1,33.6,,,percent of total billed charges,33.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,5668.12,92,,,percent of total billed charges,92% of total billed charges,653.32,5668.12,
US BX AXILLARY RT,4400105,CDM,402,RC,38505,HCPCS,Outpatient,,,6161,5236.85,,5002.73,81.2,,,percent of total billed charges,81.2% of total billed charges,2010.95,32.64,,,percent of total billed charges,32.64% of total billed charges,4559.14,74,,,percent of total billed charges,74% of total billed charges,4559.14,74,,,percent of total billed charges,74% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4127.87,67,,,percent of total billed charges,67% of total billed charges,4127.87,67,,,percent of total billed charges,67% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4682.36,76,,,percent of total billed charges,76% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,2030.67,32.96,,,percent of total billed charges,32.96% of total billed charges,685.99,105,,,Fee Schedule,pays based on EAPG rates,5544.9,90,,,percent of total billed charges,90% of total billed charges,5544.9,90,,,percent of total billed charges,90% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,5458.65,88.6,,,percent of total billed charges,88.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,4928.8,80,,,percent of total billed charges,80% of total billed charges,4928.8,80,,,percent of total billed charges,80% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,5606.51,91,,,percent of total billed charges,91% of total billed charges,2010.95,32.64,,,percent of total billed charges,32.64% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,2070.1,33.6,,,percent of total billed charges,33.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,5668.12,92,,,percent of total billed charges,92% of total billed charges,653.32,5668.12,
US BX INGUINAL LT,4400102,CDM,402,RC,38505,HCPCS,Outpatient,,,6161,5236.85,,5002.73,81.2,,,percent of total billed charges,81.2% of total billed charges,2010.95,32.64,,,percent of total billed charges,32.64% of total billed charges,4559.14,74,,,percent of total billed charges,74% of total billed charges,4559.14,74,,,percent of total billed charges,74% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4127.87,67,,,percent of total billed charges,67% of total billed charges,4127.87,67,,,percent of total billed charges,67% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4682.36,76,,,percent of total billed charges,76% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,2030.67,32.96,,,percent of total billed charges,32.96% of total billed charges,685.99,105,,,Fee Schedule,pays based on EAPG rates,5544.9,90,,,percent of total billed charges,90% of total billed charges,5544.9,90,,,percent of total billed charges,90% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,5458.65,88.6,,,percent of total billed charges,88.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,4928.8,80,,,percent of total billed charges,80% of total billed charges,4928.8,80,,,percent of total billed charges,80% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,5606.51,91,,,percent of total billed charges,91% of total billed charges,2010.95,32.64,,,percent of total billed charges,32.64% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,2070.1,33.6,,,percent of total billed charges,33.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,5668.12,92,,,percent of total billed charges,92% of total billed charges,653.32,5668.12,
US BX INGUINAL RT,4400103,CDM,402,RC,38505,HCPCS,Outpatient,,,6161,5236.85,,5002.73,81.2,,,percent of total billed charges,81.2% of total billed charges,2010.95,32.64,,,percent of total billed charges,32.64% of total billed charges,4559.14,74,,,percent of total billed charges,74% of total billed charges,4559.14,74,,,percent of total billed charges,74% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4127.87,67,,,percent of total billed charges,67% of total billed charges,4127.87,67,,,percent of total billed charges,67% of total billed charges,4374.31,71,,,percent of total billed charges,71% of total billed charges,4682.36,76,,,percent of total billed charges,76% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,2030.67,32.96,,,percent of total billed charges,32.96% of total billed charges,685.99,105,,,Fee Schedule,pays based on EAPG rates,5544.9,90,,,percent of total billed charges,90% of total billed charges,5544.9,90,,,percent of total billed charges,90% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,5458.65,88.6,,,percent of total billed charges,88.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,4928.8,80,,,percent of total billed charges,80% of total billed charges,4928.8,80,,,percent of total billed charges,80% of total billed charges,653.32,100,,,Fee Schedule,pays based on EAPG rates,5606.51,91,,,percent of total billed charges,91% of total billed charges,2010.95,32.64,,,percent of total billed charges,32.64% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,2070.1,33.6,,,percent of total billed charges,33.6% of total billed charges,672.92,103,,,Fee Schedule,pays based on EAPG rates,1971.52,32,,,percent of total billed charges,32% of total billed charges,1971.52,32,,,percent of total billed charges,32% of total billed charges,5668.12,92,,,percent of total billed charges,92% of total billed charges,653.32,5668.12,
US PARACENTESIS W/ IMAGE GUIDE,4400092,CDM,402,RC,49083,HCPCS,Outpatient,,,3413,2901.05,,2771.36,81.2,,,percent of total billed charges,81.2% of total billed charges,1114,32.64,,,percent of total billed charges,32.64% of total billed charges,2525.62,74,,,percent of total billed charges,74% of total billed charges,2525.62,74,,,percent of total billed charges,74% of total billed charges,1092.16,32,,,percent of total billed charges,32% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1092.16,32,,,percent of total billed charges,32% of total billed charges,2423.23,71,,,percent of total billed charges,71% of total billed charges,2423.23,71,,,percent of total billed charges,71% of total billed charges,2286.71,67,,,percent of total billed charges,67% of total billed charges,2286.71,67,,,percent of total billed charges,67% of total billed charges,2423.23,71,,,percent of total billed charges,71% of total billed charges,2593.88,76,,,percent of total billed charges,76% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1124.92,32.96,,,percent of total billed charges,32.96% of total billed charges,298.75,105,,,Fee Schedule,pays based on EAPG rates,3071.7,90,,,percent of total billed charges,90% of total billed charges,3071.7,90,,,percent of total billed charges,90% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,3023.92,88.6,,,percent of total billed charges,88.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1092.16,32,,,percent of total billed charges,32% of total billed charges,2730.4,80,,,percent of total billed charges,80% of total billed charges,2730.4,80,,,percent of total billed charges,80% of total billed charges,284.53,100,,,Fee Schedule,pays based on EAPG rates,3105.83,91,,,percent of total billed charges,91% of total billed charges,1114,32.64,,,percent of total billed charges,32.64% of total billed charges,1092.16,32,,,percent of total billed charges,32% of total billed charges,1146.77,33.6,,,percent of total billed charges,33.6% of total billed charges,293.06,103,,,Fee Schedule,pays based on EAPG rates,1092.16,32,,,percent of total billed charges,32% of total billed charges,1092.16,32,,,percent of total billed charges,32% of total billed charges,3139.96,92,,,percent of total billed charges,92% of total billed charges,284.53,3139.96,
US SOFT TISSUE HEAD,4400084,CDM,402,RC,76536,HCPCS,Outpatient,,,667,566.95,,541.6,81.2,,,percent of total billed charges,81.2% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,506.92,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,219.84,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,600.3,90,,,percent of total billed charges,90% of total billed charges,600.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,590.96,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,606.97,91,,,percent of total billed charges,91% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,224.11,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,613.64,92,,,percent of total billed charges,92% of total billed charges,60.19,613.64,
US SOFT TISSUE NECK,4400034,CDM,402,RC,76536,HCPCS,Outpatient,,,667,566.95,,541.6,81.2,,,percent of total billed charges,81.2% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,506.92,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,219.84,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,600.3,90,,,percent of total billed charges,90% of total billed charges,600.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,590.96,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,606.97,91,,,percent of total billed charges,91% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,224.11,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,613.64,92,,,percent of total billed charges,92% of total billed charges,60.19,613.64,
US THYROID,4400082,CDM,402,RC,76536,HCPCS,Outpatient,,,667,566.95,,541.6,81.2,,,percent of total billed charges,81.2% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,506.92,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,219.84,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,600.3,90,,,percent of total billed charges,90% of total billed charges,600.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,590.96,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,606.97,91,,,percent of total billed charges,91% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,224.11,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,613.64,92,,,percent of total billed charges,92% of total billed charges,60.19,613.64,
US CHEST LIMITED,4400081,CDM,402,RC,76604,HCPCS,Outpatient,,,312,265.2,,253.34,81.2,,,percent of total billed charges,81.2% of total billed charges,101.84,32.64,,,percent of total billed charges,32.64% of total billed charges,230.88,74,,,percent of total billed charges,74% of total billed charges,230.88,74,,,percent of total billed charges,74% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,209.04,67,,,percent of total billed charges,67% of total billed charges,209.04,67,,,percent of total billed charges,67% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,237.12,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,102.84,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,280.8,90,,,percent of total billed charges,90% of total billed charges,280.8,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,276.43,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,283.92,91,,,percent of total billed charges,91% of total billed charges,101.84,32.64,,,percent of total billed charges,32.64% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,104.83,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,287.04,92,,,percent of total billed charges,92% of total billed charges,60.19,287.04,
US SOFT TISSUE BACK UPPER,4400370,CDM,402,RC,76604,HCPCS,Outpatient,,,312,265.2,,253.34,81.2,,,percent of total billed charges,81.2% of total billed charges,101.84,32.64,,,percent of total billed charges,32.64% of total billed charges,230.88,74,,,percent of total billed charges,74% of total billed charges,230.88,74,,,percent of total billed charges,74% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,209.04,67,,,percent of total billed charges,67% of total billed charges,209.04,67,,,percent of total billed charges,67% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,237.12,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,102.84,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,280.8,90,,,percent of total billed charges,90% of total billed charges,280.8,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,276.43,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,283.92,91,,,percent of total billed charges,91% of total billed charges,101.84,32.64,,,percent of total billed charges,32.64% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,104.83,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,287.04,92,,,percent of total billed charges,92% of total billed charges,60.19,287.04,
US SOFT TISSUE CHEST,4400095,CDM,402,RC,76604,HCPCS,Outpatient,,,312,265.2,,253.34,81.2,,,percent of total billed charges,81.2% of total billed charges,101.84,32.64,,,percent of total billed charges,32.64% of total billed charges,230.88,74,,,percent of total billed charges,74% of total billed charges,230.88,74,,,percent of total billed charges,74% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,209.04,67,,,percent of total billed charges,67% of total billed charges,209.04,67,,,percent of total billed charges,67% of total billed charges,221.52,71,,,percent of total billed charges,71% of total billed charges,237.12,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,102.84,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,280.8,90,,,percent of total billed charges,90% of total billed charges,280.8,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,276.43,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,249.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,283.92,91,,,percent of total billed charges,91% of total billed charges,101.84,32.64,,,percent of total billed charges,32.64% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,104.83,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,99.84,32,,,percent of total billed charges,32% of total billed charges,99.84,32,,,percent of total billed charges,32% of total billed charges,287.04,92,,,percent of total billed charges,92% of total billed charges,60.19,287.04,
US BREAST COMP LT,4400078,CDM,402,RC,76641,HCPCS,Outpatient,,,356,302.6,,289.07,81.2,,,percent of total billed charges,81.2% of total billed charges,116.2,32.64,,,percent of total billed charges,32.64% of total billed charges,263.44,74,,,percent of total billed charges,74% of total billed charges,263.44,74,,,percent of total billed charges,74% of total billed charges,113.92,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,113.92,32,,,percent of total billed charges,32% of total billed charges,252.76,71,,,percent of total billed charges,71% of total billed charges,252.76,71,,,percent of total billed charges,71% of total billed charges,238.52,67,,,percent of total billed charges,67% of total billed charges,238.52,67,,,percent of total billed charges,67% of total billed charges,252.76,71,,,percent of total billed charges,71% of total billed charges,270.56,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,117.34,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,320.4,90,,,percent of total billed charges,90% of total billed charges,320.4,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,315.42,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,113.92,32,,,percent of total billed charges,32% of total billed charges,284.8,80,,,percent of total billed charges,80% of total billed charges,284.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,323.96,91,,,percent of total billed charges,91% of total billed charges,116.2,32.64,,,percent of total billed charges,32.64% of total billed charges,113.92,32,,,percent of total billed charges,32% of total billed charges,119.62,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,113.92,32,,,percent of total billed charges,32% of total billed charges,113.92,32,,,percent of total billed charges,32% of total billed charges,327.52,92,,,percent of total billed charges,92% of total billed charges,60.19,327.52,
US BREAST COMP RT,4400035,CDM,402,RC,76641,HCPCS,Outpatient,,,356,302.6,,289.07,81.2,,,percent of total billed charges,81.2% of total billed charges,116.2,32.64,,,percent of total billed charges,32.64% of total billed charges,263.44,74,,,percent of total billed charges,74% of total billed charges,263.44,74,,,percent of total billed charges,74% of total billed charges,113.92,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,113.92,32,,,percent of total billed charges,32% of total billed charges,252.76,71,,,percent of total billed charges,71% of total billed charges,252.76,71,,,percent of total billed charges,71% of total billed charges,238.52,67,,,percent of total billed charges,67% of total billed charges,238.52,67,,,percent of total billed charges,67% of total billed charges,252.76,71,,,percent of total billed charges,71% of total billed charges,270.56,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,117.34,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,320.4,90,,,percent of total billed charges,90% of total billed charges,320.4,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,315.42,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,113.92,32,,,percent of total billed charges,32% of total billed charges,284.8,80,,,percent of total billed charges,80% of total billed charges,284.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,323.96,91,,,percent of total billed charges,91% of total billed charges,116.2,32.64,,,percent of total billed charges,32.64% of total billed charges,113.92,32,,,percent of total billed charges,32% of total billed charges,119.62,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,113.92,32,,,percent of total billed charges,32% of total billed charges,113.92,32,,,percent of total billed charges,32% of total billed charges,327.52,92,,,percent of total billed charges,92% of total billed charges,60.19,327.52,
US BREAST COMP BILAT,4400061,CDM,402,RC,76641,HCPCS,Outpatient,,,672,571.2,,545.66,81.2,,,percent of total billed charges,81.2% of total billed charges,219.34,32.64,,,percent of total billed charges,32.64% of total billed charges,497.28,74,,,percent of total billed charges,74% of total billed charges,497.28,74,,,percent of total billed charges,74% of total billed charges,215.04,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,215.04,32,,,percent of total billed charges,32% of total billed charges,477.12,71,,,percent of total billed charges,71% of total billed charges,477.12,71,,,percent of total billed charges,71% of total billed charges,450.24,67,,,percent of total billed charges,67% of total billed charges,450.24,67,,,percent of total billed charges,67% of total billed charges,477.12,71,,,percent of total billed charges,71% of total billed charges,510.72,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,221.49,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,604.8,90,,,percent of total billed charges,90% of total billed charges,604.8,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,595.39,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,215.04,32,,,percent of total billed charges,32% of total billed charges,537.6,80,,,percent of total billed charges,80% of total billed charges,537.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,611.52,91,,,percent of total billed charges,91% of total billed charges,219.34,32.64,,,percent of total billed charges,32.64% of total billed charges,215.04,32,,,percent of total billed charges,32% of total billed charges,225.79,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,215.04,32,,,percent of total billed charges,32% of total billed charges,215.04,32,,,percent of total billed charges,32% of total billed charges,618.24,92,,,percent of total billed charges,92% of total billed charges,60.19,618.24,
US BREAST LTD LT,4400366,CDM,402,RC,76642,HCPCS,Outpatient,,,235,199.75,,190.82,81.2,,,percent of total billed charges,81.2% of total billed charges,76.7,32.64,,,percent of total billed charges,32.64% of total billed charges,173.9,74,,,percent of total billed charges,74% of total billed charges,173.9,74,,,percent of total billed charges,74% of total billed charges,75.2,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,75.2,32,,,percent of total billed charges,32% of total billed charges,166.85,71,,,percent of total billed charges,71% of total billed charges,166.85,71,,,percent of total billed charges,71% of total billed charges,157.45,67,,,percent of total billed charges,67% of total billed charges,157.45,67,,,percent of total billed charges,67% of total billed charges,166.85,71,,,percent of total billed charges,71% of total billed charges,178.6,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,77.46,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,211.5,90,,,percent of total billed charges,90% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,208.21,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,75.2,32,,,percent of total billed charges,32% of total billed charges,188,80,,,percent of total billed charges,80% of total billed charges,188,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,213.85,91,,,percent of total billed charges,91% of total billed charges,76.7,32.64,,,percent of total billed charges,32.64% of total billed charges,75.2,32,,,percent of total billed charges,32% of total billed charges,78.96,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,75.2,32,,,percent of total billed charges,32% of total billed charges,75.2,32,,,percent of total billed charges,32% of total billed charges,216.2,92,,,percent of total billed charges,92% of total billed charges,60.19,216.2,
US BREAST LTD RT,4400367,CDM,402,RC,76642,HCPCS,Outpatient,,,235,199.75,,190.82,81.2,,,percent of total billed charges,81.2% of total billed charges,76.7,32.64,,,percent of total billed charges,32.64% of total billed charges,173.9,74,,,percent of total billed charges,74% of total billed charges,173.9,74,,,percent of total billed charges,74% of total billed charges,75.2,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,75.2,32,,,percent of total billed charges,32% of total billed charges,166.85,71,,,percent of total billed charges,71% of total billed charges,166.85,71,,,percent of total billed charges,71% of total billed charges,157.45,67,,,percent of total billed charges,67% of total billed charges,157.45,67,,,percent of total billed charges,67% of total billed charges,166.85,71,,,percent of total billed charges,71% of total billed charges,178.6,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,77.46,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,211.5,90,,,percent of total billed charges,90% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,208.21,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,75.2,32,,,percent of total billed charges,32% of total billed charges,188,80,,,percent of total billed charges,80% of total billed charges,188,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,213.85,91,,,percent of total billed charges,91% of total billed charges,76.7,32.64,,,percent of total billed charges,32.64% of total billed charges,75.2,32,,,percent of total billed charges,32% of total billed charges,78.96,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,75.2,32,,,percent of total billed charges,32% of total billed charges,75.2,32,,,percent of total billed charges,32% of total billed charges,216.2,92,,,percent of total billed charges,92% of total billed charges,60.19,216.2,
US BREAST LTD BILAT,4400368,CDM,402,RC,76642,HCPCS,Outpatient,,,353,300.05,,286.64,81.2,,,percent of total billed charges,81.2% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,268.28,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,116.35,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,312.76,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,321.23,91,,,percent of total billed charges,91% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,118.61,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,324.76,92,,,percent of total billed charges,92% of total billed charges,60.19,324.76,
US ABD COMP,4400037,CDM,402,RC,76700,HCPCS,Outpatient,,,784,666.4,,636.61,81.2,,,percent of total billed charges,81.2% of total billed charges,255.9,32.64,,,percent of total billed charges,32.64% of total billed charges,580.16,74,,,percent of total billed charges,74% of total billed charges,580.16,74,,,percent of total billed charges,74% of total billed charges,250.88,32,,,percent of total billed charges,32% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,250.88,32,,,percent of total billed charges,32% of total billed charges,556.64,71,,,percent of total billed charges,71% of total billed charges,556.64,71,,,percent of total billed charges,71% of total billed charges,525.28,67,,,percent of total billed charges,67% of total billed charges,525.28,67,,,percent of total billed charges,67% of total billed charges,556.64,71,,,percent of total billed charges,71% of total billed charges,595.84,76,,,percent of total billed charges,76% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,258.41,32.96,,,percent of total billed charges,32.96% of total billed charges,97.2,105,,,Fee Schedule,pays based on EAPG rates,705.6,90,,,percent of total billed charges,90% of total billed charges,705.6,90,,,percent of total billed charges,90% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,694.62,88.6,,,percent of total billed charges,88.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,250.88,32,,,percent of total billed charges,32% of total billed charges,627.2,80,,,percent of total billed charges,80% of total billed charges,627.2,80,,,percent of total billed charges,80% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,713.44,91,,,percent of total billed charges,91% of total billed charges,255.9,32.64,,,percent of total billed charges,32.64% of total billed charges,250.88,32,,,percent of total billed charges,32% of total billed charges,263.42,33.6,,,percent of total billed charges,33.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,250.88,32,,,percent of total billed charges,32% of total billed charges,250.88,32,,,percent of total billed charges,32% of total billed charges,721.28,92,,,percent of total billed charges,92% of total billed charges,92.57,721.28,
US ABD LTD,4400036,CDM,402,RC,76705,HCPCS,Outpatient,,,541,459.85,,439.29,81.2,,,percent of total billed charges,81.2% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,411.16,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,178.31,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,486.9,90,,,percent of total billed charges,90% of total billed charges,486.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,479.33,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,492.31,91,,,percent of total billed charges,91% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,181.78,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,497.72,92,,,percent of total billed charges,92% of total billed charges,60.19,497.72,
US SOFT TISSUE ABD,4400094,CDM,402,RC,76705,HCPCS,Outpatient,,,541,459.85,,439.29,81.2,,,percent of total billed charges,81.2% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,411.16,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,178.31,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,486.9,90,,,percent of total billed charges,90% of total billed charges,486.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,479.33,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,492.31,91,,,percent of total billed charges,91% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,181.78,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,497.72,92,,,percent of total billed charges,92% of total billed charges,60.19,497.72,
US AAA SCREENING,4400033,CDM,402,RC,76706,HCPCS,Outpatient,,,541,459.85,,439.29,81.2,,,percent of total billed charges,81.2% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,411.16,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,178.31,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,486.9,90,,,percent of total billed charges,90% of total billed charges,486.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,479.33,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,492.31,91,,,percent of total billed charges,91% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,181.78,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,497.72,92,,,percent of total billed charges,92% of total billed charges,60.19,497.72,
US RENAL/BLADDER,4400038,CDM,402,RC,76770,HCPCS,Outpatient,,,557,473.45,,452.28,81.2,,,percent of total billed charges,81.2% of total billed charges,181.8,32.64,,,percent of total billed charges,32.64% of total billed charges,412.18,74,,,percent of total billed charges,74% of total billed charges,412.18,74,,,percent of total billed charges,74% of total billed charges,178.24,32,,,percent of total billed charges,32% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,178.24,32,,,percent of total billed charges,32% of total billed charges,395.47,71,,,percent of total billed charges,71% of total billed charges,395.47,71,,,percent of total billed charges,71% of total billed charges,373.19,67,,,percent of total billed charges,67% of total billed charges,373.19,67,,,percent of total billed charges,67% of total billed charges,395.47,71,,,percent of total billed charges,71% of total billed charges,423.32,76,,,percent of total billed charges,76% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,183.59,32.96,,,percent of total billed charges,32.96% of total billed charges,97.2,105,,,Fee Schedule,pays based on EAPG rates,501.3,90,,,percent of total billed charges,90% of total billed charges,501.3,90,,,percent of total billed charges,90% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,493.5,88.6,,,percent of total billed charges,88.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,178.24,32,,,percent of total billed charges,32% of total billed charges,445.6,80,,,percent of total billed charges,80% of total billed charges,445.6,80,,,percent of total billed charges,80% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,506.87,91,,,percent of total billed charges,91% of total billed charges,181.8,32.64,,,percent of total billed charges,32.64% of total billed charges,178.24,32,,,percent of total billed charges,32% of total billed charges,187.15,33.6,,,percent of total billed charges,33.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,178.24,32,,,percent of total billed charges,32% of total billed charges,178.24,32,,,percent of total billed charges,32% of total billed charges,512.44,92,,,percent of total billed charges,92% of total billed charges,92.57,512.44,
US AORTA,4400066,CDM,402,RC,76775,HCPCS,Outpatient,,,541,459.85,,439.29,81.2,,,percent of total billed charges,81.2% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,411.16,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,178.31,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,486.9,90,,,percent of total billed charges,90% of total billed charges,486.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,479.33,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,492.31,91,,,percent of total billed charges,91% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,181.78,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,497.72,92,,,percent of total billed charges,92% of total billed charges,60.19,497.72,
US RENAL LTD KIDNEYS ONLY,4400371,CDM,402,RC,76775,HCPCS,Outpatient,,,541,459.85,,439.29,81.2,,,percent of total billed charges,81.2% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,400.34,74,,,percent of total billed charges,74% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,362.47,67,,,percent of total billed charges,67% of total billed charges,384.11,71,,,percent of total billed charges,71% of total billed charges,411.16,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,178.31,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,486.9,90,,,percent of total billed charges,90% of total billed charges,486.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,479.33,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,432.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,492.31,91,,,percent of total billed charges,91% of total billed charges,176.58,32.64,,,percent of total billed charges,32.64% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,181.78,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.12,32,,,percent of total billed charges,32% of total billed charges,173.12,32,,,percent of total billed charges,32% of total billed charges,497.72,92,,,percent of total billed charges,92% of total billed charges,60.19,497.72,
US OB 1ST TRIMESTER <14 WKS SINGLE,4400064,CDM,402,RC,76801,HCPCS,Outpatient,,,708,601.8,,574.9,81.2,,,percent of total billed charges,81.2% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,538.08,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,233.36,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,637.2,90,,,percent of total billed charges,90% of total billed charges,637.2,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,627.29,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,644.28,91,,,percent of total billed charges,91% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,237.89,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,651.36,92,,,percent of total billed charges,92% of total billed charges,72.01,651.36,
US OB 1ST TRIMESTER <14 WKS ADDITIONAL G,4400069,CDM,402,RC,76802,HCPCS,Outpatient,,,708,601.8,,574.9,81.2,,,percent of total billed charges,81.2% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,538.08,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,233.36,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,637.2,90,,,percent of total billed charges,90% of total billed charges,637.2,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,627.29,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,644.28,91,,,percent of total billed charges,91% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,237.89,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,651.36,92,,,percent of total billed charges,92% of total billed charges,72.01,651.36,
US OB >14 WKS SINGLE,4400051,CDM,402,RC,76805,HCPCS,Outpatient,,,708,601.8,,574.9,81.2,,,percent of total billed charges,81.2% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,538.08,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,233.36,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,637.2,90,,,percent of total billed charges,90% of total billed charges,637.2,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,627.29,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,644.28,91,,,percent of total billed charges,91% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,237.89,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,651.36,92,,,percent of total billed charges,92% of total billed charges,72.01,651.36,
US OB >14 WKS ADDITIONAL GEST,4400070,CDM,402,RC,76810,HCPCS,Outpatient,,,708,601.8,,574.9,81.2,,,percent of total billed charges,81.2% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,538.08,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,233.36,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,637.2,90,,,percent of total billed charges,90% of total billed charges,637.2,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,627.29,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,644.28,91,,,percent of total billed charges,91% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,237.89,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,651.36,92,,,percent of total billed charges,92% of total billed charges,72.01,651.36,
US FOR POSITION DET/EXT VERSIO,4400062,CDM,402,RC,76815,HCPCS,Outpatient,,,379,322.15,,307.75,81.2,,,percent of total billed charges,81.2% of total billed charges,123.71,32.64,,,percent of total billed charges,32.64% of total billed charges,280.46,74,,,percent of total billed charges,74% of total billed charges,280.46,74,,,percent of total billed charges,74% of total billed charges,121.28,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,121.28,32,,,percent of total billed charges,32% of total billed charges,269.09,71,,,percent of total billed charges,71% of total billed charges,269.09,71,,,percent of total billed charges,71% of total billed charges,253.93,67,,,percent of total billed charges,67% of total billed charges,253.93,67,,,percent of total billed charges,67% of total billed charges,269.09,71,,,percent of total billed charges,71% of total billed charges,288.04,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,124.92,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,341.1,90,,,percent of total billed charges,90% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,335.79,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,121.28,32,,,percent of total billed charges,32% of total billed charges,303.2,80,,,percent of total billed charges,80% of total billed charges,303.2,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,344.89,91,,,percent of total billed charges,91% of total billed charges,123.71,32.64,,,percent of total billed charges,32.64% of total billed charges,121.28,32,,,percent of total billed charges,32% of total billed charges,127.34,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,121.28,32,,,percent of total billed charges,32% of total billed charges,121.28,32,,,percent of total billed charges,32% of total billed charges,348.68,92,,,percent of total billed charges,92% of total billed charges,72.01,348.68,
US OB LTD - 1 OR MORE FETUSES,4400041,CDM,402,RC,76815,HCPCS,Outpatient,,,409,347.65,,332.11,81.2,,,percent of total billed charges,81.2% of total billed charges,133.5,32.64,,,percent of total billed charges,32.64% of total billed charges,302.66,74,,,percent of total billed charges,74% of total billed charges,302.66,74,,,percent of total billed charges,74% of total billed charges,130.88,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,130.88,32,,,percent of total billed charges,32% of total billed charges,290.39,71,,,percent of total billed charges,71% of total billed charges,290.39,71,,,percent of total billed charges,71% of total billed charges,274.03,67,,,percent of total billed charges,67% of total billed charges,274.03,67,,,percent of total billed charges,67% of total billed charges,290.39,71,,,percent of total billed charges,71% of total billed charges,310.84,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,134.81,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,368.1,90,,,percent of total billed charges,90% of total billed charges,368.1,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,362.37,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,130.88,32,,,percent of total billed charges,32% of total billed charges,327.2,80,,,percent of total billed charges,80% of total billed charges,327.2,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,372.19,91,,,percent of total billed charges,91% of total billed charges,133.5,32.64,,,percent of total billed charges,32.64% of total billed charges,130.88,32,,,percent of total billed charges,32% of total billed charges,137.42,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,130.88,32,,,percent of total billed charges,32% of total billed charges,130.88,32,,,percent of total billed charges,32% of total billed charges,376.28,92,,,percent of total billed charges,92% of total billed charges,72.01,376.28,
US OB F/U,4400043,CDM,402,RC,76816,HCPCS,Outpatient,,,385,327.25,,312.62,81.2,,,percent of total billed charges,81.2% of total billed charges,125.66,32.64,,,percent of total billed charges,32.64% of total billed charges,284.9,74,,,percent of total billed charges,74% of total billed charges,284.9,74,,,percent of total billed charges,74% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,257.95,67,,,percent of total billed charges,67% of total billed charges,257.95,67,,,percent of total billed charges,67% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,292.6,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,126.9,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,346.5,90,,,percent of total billed charges,90% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,341.11,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,308,80,,,percent of total billed charges,80% of total billed charges,308,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,350.35,91,,,percent of total billed charges,91% of total billed charges,125.66,32.64,,,percent of total billed charges,32.64% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,129.36,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,354.2,92,,,percent of total billed charges,92% of total billed charges,72.01,354.2,
US OB F/U EACH ADDITION FETUS,4400073,CDM,402,RC,76816,HCPCS,Outpatient,,,385,327.25,,312.62,81.2,,,percent of total billed charges,81.2% of total billed charges,125.66,32.64,,,percent of total billed charges,32.64% of total billed charges,284.9,74,,,percent of total billed charges,74% of total billed charges,284.9,74,,,percent of total billed charges,74% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,257.95,67,,,percent of total billed charges,67% of total billed charges,257.95,67,,,percent of total billed charges,67% of total billed charges,273.35,71,,,percent of total billed charges,71% of total billed charges,292.6,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,126.9,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,346.5,90,,,percent of total billed charges,90% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,341.11,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,308,80,,,percent of total billed charges,80% of total billed charges,308,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,350.35,91,,,percent of total billed charges,91% of total billed charges,125.66,32.64,,,percent of total billed charges,32.64% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,129.36,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,123.2,32,,,percent of total billed charges,32% of total billed charges,123.2,32,,,percent of total billed charges,32% of total billed charges,354.2,92,,,percent of total billed charges,92% of total billed charges,72.01,354.2,
US TRANSVAGINAL OB,4400063,CDM,402,RC,76817,HCPCS,Outpatient,,,708,601.8,,574.9,81.2,,,percent of total billed charges,81.2% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,523.92,74,,,percent of total billed charges,74% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,474.36,67,,,percent of total billed charges,67% of total billed charges,502.68,71,,,percent of total billed charges,71% of total billed charges,538.08,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,233.36,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,637.2,90,,,percent of total billed charges,90% of total billed charges,637.2,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,627.29,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,566.4,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,644.28,91,,,percent of total billed charges,91% of total billed charges,231.09,32.64,,,percent of total billed charges,32.64% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,237.89,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,226.56,32,,,percent of total billed charges,32% of total billed charges,226.56,32,,,percent of total billed charges,32% of total billed charges,651.36,92,,,percent of total billed charges,92% of total billed charges,72.01,651.36,
US BPP EACH ADDITIONAL GESTATION,4400005,CDM,402,RC,76819,HCPCS,Outpatient,,,503,427.55,,408.44,81.2,,,percent of total billed charges,81.2% of total billed charges,164.18,32.64,,,percent of total billed charges,32.64% of total billed charges,372.22,74,,,percent of total billed charges,74% of total billed charges,372.22,74,,,percent of total billed charges,74% of total billed charges,160.96,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,160.96,32,,,percent of total billed charges,32% of total billed charges,357.13,71,,,percent of total billed charges,71% of total billed charges,357.13,71,,,percent of total billed charges,71% of total billed charges,337.01,67,,,percent of total billed charges,67% of total billed charges,337.01,67,,,percent of total billed charges,67% of total billed charges,357.13,71,,,percent of total billed charges,71% of total billed charges,382.28,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,165.79,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,452.7,90,,,percent of total billed charges,90% of total billed charges,452.7,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,445.66,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,160.96,32,,,percent of total billed charges,32% of total billed charges,402.4,80,,,percent of total billed charges,80% of total billed charges,402.4,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,457.73,91,,,percent of total billed charges,91% of total billed charges,164.18,32.64,,,percent of total billed charges,32.64% of total billed charges,160.96,32,,,percent of total billed charges,32% of total billed charges,169.01,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,160.96,32,,,percent of total billed charges,32% of total billed charges,160.96,32,,,percent of total billed charges,32% of total billed charges,462.76,92,,,percent of total billed charges,92% of total billed charges,72.01,462.76,
US BPP,4400068,CDM,402,RC,76819,HCPCS,Outpatient,,,529,449.65,,429.55,81.2,,,percent of total billed charges,81.2% of total billed charges,172.67,32.64,,,percent of total billed charges,32.64% of total billed charges,391.46,74,,,percent of total billed charges,74% of total billed charges,391.46,74,,,percent of total billed charges,74% of total billed charges,169.28,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,169.28,32,,,percent of total billed charges,32% of total billed charges,375.59,71,,,percent of total billed charges,71% of total billed charges,375.59,71,,,percent of total billed charges,71% of total billed charges,354.43,67,,,percent of total billed charges,67% of total billed charges,354.43,67,,,percent of total billed charges,67% of total billed charges,375.59,71,,,percent of total billed charges,71% of total billed charges,402.04,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,174.36,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,476.1,90,,,percent of total billed charges,90% of total billed charges,476.1,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,468.69,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,169.28,32,,,percent of total billed charges,32% of total billed charges,423.2,80,,,percent of total billed charges,80% of total billed charges,423.2,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,481.39,91,,,percent of total billed charges,91% of total billed charges,172.67,32.64,,,percent of total billed charges,32.64% of total billed charges,169.28,32,,,percent of total billed charges,32% of total billed charges,177.74,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,169.28,32,,,percent of total billed charges,32% of total billed charges,169.28,32,,,percent of total billed charges,32% of total billed charges,486.68,92,,,percent of total billed charges,92% of total billed charges,72.01,486.68,
US UMBILICAL CORD DOPPLER,4400372,CDM,402,RC,76820,HCPCS,Outpatient,,,354,300.9,,287.45,81.2,,,percent of total billed charges,81.2% of total billed charges,115.55,32.64,,,percent of total billed charges,32.64% of total billed charges,261.96,74,,,percent of total billed charges,74% of total billed charges,261.96,74,,,percent of total billed charges,74% of total billed charges,113.28,32,,,percent of total billed charges,32% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,113.28,32,,,percent of total billed charges,32% of total billed charges,251.34,71,,,percent of total billed charges,71% of total billed charges,251.34,71,,,percent of total billed charges,71% of total billed charges,237.18,67,,,percent of total billed charges,67% of total billed charges,237.18,67,,,percent of total billed charges,67% of total billed charges,251.34,71,,,percent of total billed charges,71% of total billed charges,269.04,76,,,percent of total billed charges,76% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,116.68,32.96,,,percent of total billed charges,32.96% of total billed charges,75.61,105,,,Fee Schedule,pays based on EAPG rates,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,313.64,88.6,,,percent of total billed charges,88.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,113.28,32,,,percent of total billed charges,32% of total billed charges,283.2,80,,,percent of total billed charges,80% of total billed charges,283.2,80,,,percent of total billed charges,80% of total billed charges,72.01,100,,,Fee Schedule,pays based on EAPG rates,322.14,91,,,percent of total billed charges,91% of total billed charges,115.55,32.64,,,percent of total billed charges,32.64% of total billed charges,113.28,32,,,percent of total billed charges,32% of total billed charges,118.94,33.6,,,percent of total billed charges,33.6% of total billed charges,74.17,103,,,Fee Schedule,pays based on EAPG rates,113.28,32,,,percent of total billed charges,32% of total billed charges,113.28,32,,,percent of total billed charges,32% of total billed charges,325.68,92,,,percent of total billed charges,92% of total billed charges,72.01,325.68,
US TRANSVAGINAL NON OB,4400032,CDM,402,RC,76830,HCPCS,Outpatient,,,667,566.95,,541.6,81.2,,,percent of total billed charges,81.2% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,506.92,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,219.84,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,600.3,90,,,percent of total billed charges,90% of total billed charges,600.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,590.96,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,606.97,91,,,percent of total billed charges,91% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,224.11,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,613.64,92,,,percent of total billed charges,92% of total billed charges,60.19,613.64,
US PELVIS,4400042,CDM,402,RC,76856,HCPCS,Outpatient,,,674,572.9,,547.29,81.2,,,percent of total billed charges,81.2% of total billed charges,219.99,32.64,,,percent of total billed charges,32.64% of total billed charges,498.76,74,,,percent of total billed charges,74% of total billed charges,498.76,74,,,percent of total billed charges,74% of total billed charges,215.68,32,,,percent of total billed charges,32% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,215.68,32,,,percent of total billed charges,32% of total billed charges,478.54,71,,,percent of total billed charges,71% of total billed charges,478.54,71,,,percent of total billed charges,71% of total billed charges,451.58,67,,,percent of total billed charges,67% of total billed charges,451.58,67,,,percent of total billed charges,67% of total billed charges,478.54,71,,,percent of total billed charges,71% of total billed charges,512.24,76,,,percent of total billed charges,76% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,222.15,32.96,,,percent of total billed charges,32.96% of total billed charges,97.2,105,,,Fee Schedule,pays based on EAPG rates,606.6,90,,,percent of total billed charges,90% of total billed charges,606.6,90,,,percent of total billed charges,90% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,597.16,88.6,,,percent of total billed charges,88.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,215.68,32,,,percent of total billed charges,32% of total billed charges,539.2,80,,,percent of total billed charges,80% of total billed charges,539.2,80,,,percent of total billed charges,80% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,613.34,91,,,percent of total billed charges,91% of total billed charges,219.99,32.64,,,percent of total billed charges,32.64% of total billed charges,215.68,32,,,percent of total billed charges,32% of total billed charges,226.46,33.6,,,percent of total billed charges,33.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,215.68,32,,,percent of total billed charges,32% of total billed charges,215.68,32,,,percent of total billed charges,32% of total billed charges,620.08,92,,,percent of total billed charges,92% of total billed charges,92.57,620.08,
US BLADDER PRE/POST VOID,4400039,CDM,402,RC,76857,HCPCS,Outpatient,,,209,177.65,,169.71,81.2,,,percent of total billed charges,81.2% of total billed charges,68.22,32.64,,,percent of total billed charges,32.64% of total billed charges,154.66,74,,,percent of total billed charges,74% of total billed charges,154.66,74,,,percent of total billed charges,74% of total billed charges,66.88,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,66.88,32,,,percent of total billed charges,32% of total billed charges,148.39,71,,,percent of total billed charges,71% of total billed charges,148.39,71,,,percent of total billed charges,71% of total billed charges,140.03,67,,,percent of total billed charges,67% of total billed charges,140.03,67,,,percent of total billed charges,67% of total billed charges,148.39,71,,,percent of total billed charges,71% of total billed charges,158.84,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,68.89,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,188.1,90,,,percent of total billed charges,90% of total billed charges,188.1,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,185.17,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,66.88,32,,,percent of total billed charges,32% of total billed charges,167.2,80,,,percent of total billed charges,80% of total billed charges,167.2,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,190.19,91,,,percent of total billed charges,91% of total billed charges,68.22,32.64,,,percent of total billed charges,32.64% of total billed charges,66.88,32,,,percent of total billed charges,32% of total billed charges,70.22,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,66.88,32,,,percent of total billed charges,32% of total billed charges,66.88,32,,,percent of total billed charges,32% of total billed charges,192.28,92,,,percent of total billed charges,92% of total billed charges,60.19,192.28,
US PELVIS LIMITED OR FOLLOW UP,4400065,CDM,402,RC,76857,HCPCS,Outpatient,,,667,566.95,,541.6,81.2,,,percent of total billed charges,81.2% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,506.92,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,219.84,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,600.3,90,,,percent of total billed charges,90% of total billed charges,600.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,590.96,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,606.97,91,,,percent of total billed charges,91% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,224.11,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,613.64,92,,,percent of total billed charges,92% of total billed charges,60.19,613.64,
US SCROTUM,4400047,CDM,402,RC,76870,HCPCS,Outpatient,,,667,566.95,,541.6,81.2,,,percent of total billed charges,81.2% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,493.58,74,,,percent of total billed charges,74% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,446.89,67,,,percent of total billed charges,67% of total billed charges,473.57,71,,,percent of total billed charges,71% of total billed charges,506.92,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,219.84,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,600.3,90,,,percent of total billed charges,90% of total billed charges,600.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,590.96,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,533.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,606.97,91,,,percent of total billed charges,91% of total billed charges,217.71,32.64,,,percent of total billed charges,32.64% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,224.11,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,213.44,32,,,percent of total billed charges,32% of total billed charges,213.44,32,,,percent of total billed charges,32% of total billed charges,613.64,92,,,percent of total billed charges,92% of total billed charges,60.19,613.64,
US SOFT TISSUE,4400058,CDM,320,RC,76881,HCPCS,Outpatient,,,297,252.45,,241.16,81.2,,,percent of total billed charges,81.2% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,225.72,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,97.89,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,267.3,90,,,percent of total billed charges,90% of total billed charges,267.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,263.14,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,270.27,91,,,percent of total billed charges,91% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,99.79,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,273.24,92,,,percent of total billed charges,92% of total billed charges,60.19,273.24,
US SOFT TISSUE LOW EXT LT,4400091,CDM,402,RC,76882,HCPCS,Outpatient,,,297,252.45,,241.16,81.2,,,percent of total billed charges,81.2% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,225.72,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,97.89,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,267.3,90,,,percent of total billed charges,90% of total billed charges,267.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,263.14,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,270.27,91,,,percent of total billed charges,91% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,99.79,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,273.24,92,,,percent of total billed charges,92% of total billed charges,60.19,273.24,
US SOFT TISSUE LOW EXT RT,4400090,CDM,402,RC,76882,HCPCS,Outpatient,,,297,252.45,,241.16,81.2,,,percent of total billed charges,81.2% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,225.72,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,97.89,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,267.3,90,,,percent of total billed charges,90% of total billed charges,267.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,263.14,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,270.27,91,,,percent of total billed charges,91% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,99.79,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,273.24,92,,,percent of total billed charges,92% of total billed charges,60.19,273.24,
US SOFT TISSUE UPP EXT LT,4400089,CDM,402,RC,76882,HCPCS,Outpatient,,,297,252.45,,241.16,81.2,,,percent of total billed charges,81.2% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,225.72,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,97.89,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,267.3,90,,,percent of total billed charges,90% of total billed charges,267.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,263.14,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,270.27,91,,,percent of total billed charges,91% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,99.79,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,273.24,92,,,percent of total billed charges,92% of total billed charges,60.19,273.24,
US SOFT TISSUE UPP EXT RT,4400088,CDM,402,RC,76882,HCPCS,Outpatient,,,297,252.45,,241.16,81.2,,,percent of total billed charges,81.2% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,219.78,74,,,percent of total billed charges,74% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,198.99,67,,,percent of total billed charges,67% of total billed charges,210.87,71,,,percent of total billed charges,71% of total billed charges,225.72,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,97.89,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,267.3,90,,,percent of total billed charges,90% of total billed charges,267.3,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,263.14,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,237.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,270.27,91,,,percent of total billed charges,91% of total billed charges,96.94,32.64,,,percent of total billed charges,32.64% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,99.79,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,95.04,32,,,percent of total billed charges,32% of total billed charges,95.04,32,,,percent of total billed charges,32% of total billed charges,273.24,92,,,percent of total billed charges,92% of total billed charges,60.19,273.24,
US AXILLA LT,4400048,CDM,402,RC,76882,HCPCS,Outpatient,,,362,307.7,,293.94,81.2,,,percent of total billed charges,81.2% of total billed charges,118.16,32.64,,,percent of total billed charges,32.64% of total billed charges,267.88,74,,,percent of total billed charges,74% of total billed charges,267.88,74,,,percent of total billed charges,74% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,242.54,67,,,percent of total billed charges,67% of total billed charges,242.54,67,,,percent of total billed charges,67% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,275.12,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,119.32,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,325.8,90,,,percent of total billed charges,90% of total billed charges,325.8,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,320.73,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,289.6,80,,,percent of total billed charges,80% of total billed charges,289.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,329.42,91,,,percent of total billed charges,91% of total billed charges,118.16,32.64,,,percent of total billed charges,32.64% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,121.63,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,333.04,92,,,percent of total billed charges,92% of total billed charges,60.19,333.04,
US AXILLA RT,4400057,CDM,402,RC,76882,HCPCS,Outpatient,,,362,307.7,,293.94,81.2,,,percent of total billed charges,81.2% of total billed charges,118.16,32.64,,,percent of total billed charges,32.64% of total billed charges,267.88,74,,,percent of total billed charges,74% of total billed charges,267.88,74,,,percent of total billed charges,74% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,242.54,67,,,percent of total billed charges,67% of total billed charges,242.54,67,,,percent of total billed charges,67% of total billed charges,257.02,71,,,percent of total billed charges,71% of total billed charges,275.12,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,119.32,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,325.8,90,,,percent of total billed charges,90% of total billed charges,325.8,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,320.73,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,289.6,80,,,percent of total billed charges,80% of total billed charges,289.6,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,329.42,91,,,percent of total billed charges,91% of total billed charges,118.16,32.64,,,percent of total billed charges,32.64% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,121.63,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,115.84,32,,,percent of total billed charges,32% of total billed charges,115.84,32,,,percent of total billed charges,32% of total billed charges,333.04,92,,,percent of total billed charges,92% of total billed charges,60.19,333.04,
US SOFT TISSUE UPP EXT BIL,4400376,CDM,402,RC,76882,HCPCS,Outpatient,,,445,378.25,,361.34,81.2,,,percent of total billed charges,81.2% of total billed charges,145.25,32.64,,,percent of total billed charges,32.64% of total billed charges,329.3,74,,,percent of total billed charges,74% of total billed charges,329.3,74,,,percent of total billed charges,74% of total billed charges,142.4,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,142.4,32,,,percent of total billed charges,32% of total billed charges,315.95,71,,,percent of total billed charges,71% of total billed charges,315.95,71,,,percent of total billed charges,71% of total billed charges,298.15,67,,,percent of total billed charges,67% of total billed charges,298.15,67,,,percent of total billed charges,67% of total billed charges,315.95,71,,,percent of total billed charges,71% of total billed charges,338.2,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,146.67,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,400.5,90,,,percent of total billed charges,90% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,394.27,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,142.4,32,,,percent of total billed charges,32% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,356,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,404.95,91,,,percent of total billed charges,91% of total billed charges,145.25,32.64,,,percent of total billed charges,32.64% of total billed charges,142.4,32,,,percent of total billed charges,32% of total billed charges,149.52,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,142.4,32,,,percent of total billed charges,32% of total billed charges,142.4,32,,,percent of total billed charges,32% of total billed charges,409.4,92,,,percent of total billed charges,92% of total billed charges,60.19,409.4,
US AXILLA BILAT,4400098,CDM,402,RC,76882,HCPCS,Outpatient,,,543,461.55,,440.92,81.2,,,percent of total billed charges,81.2% of total billed charges,177.24,32.64,,,percent of total billed charges,32.64% of total billed charges,401.82,74,,,percent of total billed charges,74% of total billed charges,401.82,74,,,percent of total billed charges,74% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,363.81,67,,,percent of total billed charges,67% of total billed charges,363.81,67,,,percent of total billed charges,67% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,412.68,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,178.97,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,488.7,90,,,percent of total billed charges,90% of total billed charges,488.7,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,481.1,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,434.4,80,,,percent of total billed charges,80% of total billed charges,434.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,494.13,91,,,percent of total billed charges,91% of total billed charges,177.24,32.64,,,percent of total billed charges,32.64% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,182.45,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,499.56,92,,,percent of total billed charges,92% of total billed charges,60.19,499.56,
US GUIDE FOR NEEDLE BIOPSY,4400049,CDM,402,RC,76942,HCPCS,Outpatient,,,540,459,,438.48,81.2,,,percent of total billed charges,81.2% of total billed charges,176.26,32.64,,,percent of total billed charges,32.64% of total billed charges,399.6,74,,,percent of total billed charges,74% of total billed charges,399.6,74,,,percent of total billed charges,74% of total billed charges,172.8,32,,,percent of total billed charges,32% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,172.8,32,,,percent of total billed charges,32% of total billed charges,383.4,71,,,percent of total billed charges,71% of total billed charges,383.4,71,,,percent of total billed charges,71% of total billed charges,361.8,67,,,percent of total billed charges,67% of total billed charges,361.8,67,,,percent of total billed charges,67% of total billed charges,383.4,71,,,percent of total billed charges,71% of total billed charges,410.4,76,,,percent of total billed charges,76% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,177.98,32.96,,,percent of total billed charges,32.96% of total billed charges,60.29,105,,,Fee Schedule,pays based on EAPG rates,486,90,,,percent of total billed charges,90% of total billed charges,486,90,,,percent of total billed charges,90% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,478.44,88.6,,,percent of total billed charges,88.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,172.8,32,,,percent of total billed charges,32% of total billed charges,432,80,,,percent of total billed charges,80% of total billed charges,432,80,,,percent of total billed charges,80% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,491.4,91,,,percent of total billed charges,91% of total billed charges,176.26,32.64,,,percent of total billed charges,32.64% of total billed charges,172.8,32,,,percent of total billed charges,32% of total billed charges,181.44,33.6,,,percent of total billed charges,33.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,172.8,32,,,percent of total billed charges,32% of total billed charges,172.8,32,,,percent of total billed charges,32% of total billed charges,496.8,92,,,percent of total billed charges,92% of total billed charges,57.42,496.8,
US GUIDANCE AMNIO,4400044,CDM,402,RC,76946,HCPCS,Outpatient,,,508,431.8,,412.5,81.2,,,percent of total billed charges,81.2% of total billed charges,165.81,32.64,,,percent of total billed charges,32.64% of total billed charges,375.92,74,,,percent of total billed charges,74% of total billed charges,375.92,74,,,percent of total billed charges,74% of total billed charges,162.56,32,,,percent of total billed charges,32% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,162.56,32,,,percent of total billed charges,32% of total billed charges,360.68,71,,,percent of total billed charges,71% of total billed charges,360.68,71,,,percent of total billed charges,71% of total billed charges,340.36,67,,,percent of total billed charges,67% of total billed charges,340.36,67,,,percent of total billed charges,67% of total billed charges,360.68,71,,,percent of total billed charges,71% of total billed charges,386.08,76,,,percent of total billed charges,76% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,167.44,32.96,,,percent of total billed charges,32.96% of total billed charges,60.29,105,,,Fee Schedule,pays based on EAPG rates,457.2,90,,,percent of total billed charges,90% of total billed charges,457.2,90,,,percent of total billed charges,90% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,450.09,88.6,,,percent of total billed charges,88.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,162.56,32,,,percent of total billed charges,32% of total billed charges,406.4,80,,,percent of total billed charges,80% of total billed charges,406.4,80,,,percent of total billed charges,80% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,462.28,91,,,percent of total billed charges,91% of total billed charges,165.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.56,32,,,percent of total billed charges,32% of total billed charges,170.69,33.6,,,percent of total billed charges,33.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,162.56,32,,,percent of total billed charges,32% of total billed charges,162.56,32,,,percent of total billed charges,32% of total billed charges,467.36,92,,,percent of total billed charges,92% of total billed charges,57.42,467.36,
US LIVER ELASTOGRAPHY,4400099,CDM,402,RC,76981,HCPCS,Outpatient,,,549,466.65,,445.79,81.2,,,percent of total billed charges,81.2% of total billed charges,179.19,32.64,,,percent of total billed charges,32.64% of total billed charges,406.26,74,,,percent of total billed charges,74% of total billed charges,406.26,74,,,percent of total billed charges,74% of total billed charges,175.68,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,175.68,32,,,percent of total billed charges,32% of total billed charges,389.79,71,,,percent of total billed charges,71% of total billed charges,389.79,71,,,percent of total billed charges,71% of total billed charges,367.83,67,,,percent of total billed charges,67% of total billed charges,367.83,67,,,percent of total billed charges,67% of total billed charges,389.79,71,,,percent of total billed charges,71% of total billed charges,417.24,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,180.95,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,494.1,90,,,percent of total billed charges,90% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,486.41,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,175.68,32,,,percent of total billed charges,32% of total billed charges,439.2,80,,,percent of total billed charges,80% of total billed charges,439.2,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,499.59,91,,,percent of total billed charges,91% of total billed charges,179.19,32.64,,,percent of total billed charges,32.64% of total billed charges,175.68,32,,,percent of total billed charges,32% of total billed charges,184.46,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,175.68,32,,,percent of total billed charges,32% of total billed charges,175.68,32,,,percent of total billed charges,32% of total billed charges,505.08,92,,,percent of total billed charges,92% of total billed charges,60.19,505.08,
US ELASTO 1ST LESION,4400100,CDM,402,RC,76982,HCPCS,Outpatient,,,549,466.65,,445.79,81.2,,,percent of total billed charges,81.2% of total billed charges,179.19,32.64,,,percent of total billed charges,32.64% of total billed charges,406.26,74,,,percent of total billed charges,74% of total billed charges,406.26,74,,,percent of total billed charges,74% of total billed charges,175.68,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,175.68,32,,,percent of total billed charges,32% of total billed charges,389.79,71,,,percent of total billed charges,71% of total billed charges,389.79,71,,,percent of total billed charges,71% of total billed charges,367.83,67,,,percent of total billed charges,67% of total billed charges,367.83,67,,,percent of total billed charges,67% of total billed charges,389.79,71,,,percent of total billed charges,71% of total billed charges,417.24,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,180.95,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,494.1,90,,,percent of total billed charges,90% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,486.41,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,175.68,32,,,percent of total billed charges,32% of total billed charges,439.2,80,,,percent of total billed charges,80% of total billed charges,439.2,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,499.59,91,,,percent of total billed charges,91% of total billed charges,179.19,32.64,,,percent of total billed charges,32.64% of total billed charges,175.68,32,,,percent of total billed charges,32% of total billed charges,184.46,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,175.68,32,,,percent of total billed charges,32% of total billed charges,175.68,32,,,percent of total billed charges,32% of total billed charges,505.08,92,,,percent of total billed charges,92% of total billed charges,60.19,505.08,
US ELASTO EA ADDL LESION,4400101,CDM,402,RC,76983,HCPCS,Outpatient,,,275,233.75,,223.3,81.2,,,percent of total billed charges,81.2% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,203.5,74,,,percent of total billed charges,74% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,184.25,67,,,percent of total billed charges,67% of total billed charges,195.25,71,,,percent of total billed charges,71% of total billed charges,209,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,90.64,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,247.5,90,,,percent of total billed charges,90% of total billed charges,247.5,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,243.65,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,220,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,250.25,91,,,percent of total billed charges,91% of total billed charges,89.76,32.64,,,percent of total billed charges,32.64% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,92.4,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,88,32,,,percent of total billed charges,32% of total billed charges,88,32,,,percent of total billed charges,32% of total billed charges,253,92,,,percent of total billed charges,92% of total billed charges,60.19,253,
US GUIDANCE (OR) TC ONLY,4400031,CDM,402,RC,76998,HCPCS,Outpatient,,,400,340,,324.8,81.2,,,percent of total billed charges,81.2% of total billed charges,130.56,32.64,,,percent of total billed charges,32.64% of total billed charges,296,74,,,percent of total billed charges,74% of total billed charges,296,74,,,percent of total billed charges,74% of total billed charges,128,32,,,percent of total billed charges,32% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,128,32,,,percent of total billed charges,32% of total billed charges,284,71,,,percent of total billed charges,71% of total billed charges,284,71,,,percent of total billed charges,71% of total billed charges,268,67,,,percent of total billed charges,67% of total billed charges,268,67,,,percent of total billed charges,67% of total billed charges,284,71,,,percent of total billed charges,71% of total billed charges,304,76,,,percent of total billed charges,76% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,131.84,32.96,,,percent of total billed charges,32.96% of total billed charges,60.29,105,,,Fee Schedule,pays based on EAPG rates,360,90,,,percent of total billed charges,90% of total billed charges,360,90,,,percent of total billed charges,90% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,354.4,88.6,,,percent of total billed charges,88.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,128,32,,,percent of total billed charges,32% of total billed charges,320,80,,,percent of total billed charges,80% of total billed charges,320,80,,,percent of total billed charges,80% of total billed charges,57.42,100,,,Fee Schedule,pays based on EAPG rates,364,91,,,percent of total billed charges,91% of total billed charges,130.56,32.64,,,percent of total billed charges,32.64% of total billed charges,128,32,,,percent of total billed charges,32% of total billed charges,134.4,33.6,,,percent of total billed charges,33.6% of total billed charges,59.14,103,,,Fee Schedule,pays based on EAPG rates,128,32,,,percent of total billed charges,32% of total billed charges,128,32,,,percent of total billed charges,32% of total billed charges,368,92,,,percent of total billed charges,92% of total billed charges,57.42,368,
US LIVER DUPLEX/DOPPLER,4400374,CDM,402,RC,93975,HCPCS,Outpatient,,,722,613.7,,586.26,81.2,,,percent of total billed charges,81.2% of total billed charges,235.66,32.64,,,percent of total billed charges,32.64% of total billed charges,534.28,74,,,percent of total billed charges,74% of total billed charges,534.28,74,,,percent of total billed charges,74% of total billed charges,231.04,32,,,percent of total billed charges,32% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,231.04,32,,,percent of total billed charges,32% of total billed charges,512.62,71,,,percent of total billed charges,71% of total billed charges,512.62,71,,,percent of total billed charges,71% of total billed charges,483.74,67,,,percent of total billed charges,67% of total billed charges,483.74,67,,,percent of total billed charges,67% of total billed charges,512.62,71,,,percent of total billed charges,71% of total billed charges,548.72,76,,,percent of total billed charges,76% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,237.97,32.96,,,percent of total billed charges,32.96% of total billed charges,97.2,105,,,Fee Schedule,pays based on EAPG rates,649.8,90,,,percent of total billed charges,90% of total billed charges,649.8,90,,,percent of total billed charges,90% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,639.69,88.6,,,percent of total billed charges,88.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,231.04,32,,,percent of total billed charges,32% of total billed charges,577.6,80,,,percent of total billed charges,80% of total billed charges,577.6,80,,,percent of total billed charges,80% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,657.02,91,,,percent of total billed charges,91% of total billed charges,235.66,32.64,,,percent of total billed charges,32.64% of total billed charges,231.04,32,,,percent of total billed charges,32% of total billed charges,242.59,33.6,,,percent of total billed charges,33.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,231.04,32,,,percent of total billed charges,32% of total billed charges,231.04,32,,,percent of total billed charges,32% of total billed charges,664.24,92,,,percent of total billed charges,92% of total billed charges,92.57,664.24,
ECHO TTE W/ DOPPLER CMPLT,5000017,CDM,483,RC,93306,HCPCS,Outpatient,,,1211,1029.35,,983.33,81.2,,,percent of total billed charges,81.2% of total billed charges,395.27,32.64,,,percent of total billed charges,32.64% of total billed charges,896.14,74,,,percent of total billed charges,74% of total billed charges,896.14,74,,,percent of total billed charges,74% of total billed charges,387.52,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,387.52,32,,,percent of total billed charges,32% of total billed charges,859.81,71,,,percent of total billed charges,71% of total billed charges,859.81,71,,,percent of total billed charges,71% of total billed charges,811.37,67,,,percent of total billed charges,67% of total billed charges,811.37,67,,,percent of total billed charges,67% of total billed charges,859.81,71,,,percent of total billed charges,71% of total billed charges,920.36,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,399.15,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,1089.9,90,,,percent of total billed charges,90% of total billed charges,1089.9,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1072.95,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,387.52,32,,,percent of total billed charges,32% of total billed charges,968.8,80,,,percent of total billed charges,80% of total billed charges,968.8,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1102.01,91,,,percent of total billed charges,91% of total billed charges,395.27,32.64,,,percent of total billed charges,32.64% of total billed charges,387.52,32,,,percent of total billed charges,32% of total billed charges,406.9,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,387.52,32,,,percent of total billed charges,32% of total billed charges,387.52,32,,,percent of total billed charges,32% of total billed charges,1114.12,92,,,percent of total billed charges,92% of total billed charges,217.67,1114.12,
ECHO TTE W/ DOPPLER CMPLT W/ CONTRAST,5000043,CDM,483,RC,93306,HCPCS,Outpatient,,,1211,1029.35,,983.33,81.2,,,percent of total billed charges,81.2% of total billed charges,395.27,32.64,,,percent of total billed charges,32.64% of total billed charges,896.14,74,,,percent of total billed charges,74% of total billed charges,896.14,74,,,percent of total billed charges,74% of total billed charges,387.52,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,387.52,32,,,percent of total billed charges,32% of total billed charges,859.81,71,,,percent of total billed charges,71% of total billed charges,859.81,71,,,percent of total billed charges,71% of total billed charges,811.37,67,,,percent of total billed charges,67% of total billed charges,811.37,67,,,percent of total billed charges,67% of total billed charges,859.81,71,,,percent of total billed charges,71% of total billed charges,920.36,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,399.15,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,1089.9,90,,,percent of total billed charges,90% of total billed charges,1089.9,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1072.95,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,387.52,32,,,percent of total billed charges,32% of total billed charges,968.8,80,,,percent of total billed charges,80% of total billed charges,968.8,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1102.01,91,,,percent of total billed charges,91% of total billed charges,395.27,32.64,,,percent of total billed charges,32.64% of total billed charges,387.52,32,,,percent of total billed charges,32% of total billed charges,406.9,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,387.52,32,,,percent of total billed charges,32% of total billed charges,387.52,32,,,percent of total billed charges,32% of total billed charges,1114.12,92,,,percent of total billed charges,92% of total billed charges,217.67,1114.12,
TTE W/O COLOR DOPPLER,5000051,CDM,483,RC,93307,HCPCS,Outpatient,,,1534,1303.9,,1245.61,81.2,,,percent of total billed charges,81.2% of total billed charges,500.7,32.64,,,percent of total billed charges,32.64% of total billed charges,1135.16,74,,,percent of total billed charges,74% of total billed charges,1135.16,74,,,percent of total billed charges,74% of total billed charges,490.88,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,490.88,32,,,percent of total billed charges,32% of total billed charges,1089.14,71,,,percent of total billed charges,71% of total billed charges,1089.14,71,,,percent of total billed charges,71% of total billed charges,1027.78,67,,,percent of total billed charges,67% of total billed charges,1027.78,67,,,percent of total billed charges,67% of total billed charges,1089.14,71,,,percent of total billed charges,71% of total billed charges,1165.84,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,505.61,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,1380.6,90,,,percent of total billed charges,90% of total billed charges,1380.6,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1359.12,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,490.88,32,,,percent of total billed charges,32% of total billed charges,1227.2,80,,,percent of total billed charges,80% of total billed charges,1227.2,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1395.94,91,,,percent of total billed charges,91% of total billed charges,500.7,32.64,,,percent of total billed charges,32.64% of total billed charges,490.88,32,,,percent of total billed charges,32% of total billed charges,515.42,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,490.88,32,,,percent of total billed charges,32% of total billed charges,490.88,32,,,percent of total billed charges,32% of total billed charges,1411.28,92,,,percent of total billed charges,92% of total billed charges,217.67,1411.28,
ECHO TTE F/U OR LMTD W/ CONTRAST,5000044,CDM,483,RC,93308,HCPCS,Outpatient,,,736,625.6,,597.63,81.2,,,percent of total billed charges,81.2% of total billed charges,240.23,32.64,,,percent of total billed charges,32.64% of total billed charges,544.64,74,,,percent of total billed charges,74% of total billed charges,544.64,74,,,percent of total billed charges,74% of total billed charges,235.52,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,235.52,32,,,percent of total billed charges,32% of total billed charges,522.56,71,,,percent of total billed charges,71% of total billed charges,522.56,71,,,percent of total billed charges,71% of total billed charges,493.12,67,,,percent of total billed charges,67% of total billed charges,493.12,67,,,percent of total billed charges,67% of total billed charges,522.56,71,,,percent of total billed charges,71% of total billed charges,559.36,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,242.59,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,662.4,90,,,percent of total billed charges,90% of total billed charges,662.4,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,652.1,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,235.52,32,,,percent of total billed charges,32% of total billed charges,588.8,80,,,percent of total billed charges,80% of total billed charges,588.8,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,669.76,91,,,percent of total billed charges,91% of total billed charges,240.23,32.64,,,percent of total billed charges,32.64% of total billed charges,235.52,32,,,percent of total billed charges,32% of total billed charges,247.3,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,235.52,32,,,percent of total billed charges,32% of total billed charges,235.52,32,,,percent of total billed charges,32% of total billed charges,677.12,92,,,percent of total billed charges,92% of total billed charges,217.67,677.12,
ECHO TTE FOLLOW-UP OR LIMITED,5000030,CDM,483,RC,93308,HCPCS,Outpatient,,,736,625.6,,597.63,81.2,,,percent of total billed charges,81.2% of total billed charges,240.23,32.64,,,percent of total billed charges,32.64% of total billed charges,544.64,74,,,percent of total billed charges,74% of total billed charges,544.64,74,,,percent of total billed charges,74% of total billed charges,235.52,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,235.52,32,,,percent of total billed charges,32% of total billed charges,522.56,71,,,percent of total billed charges,71% of total billed charges,522.56,71,,,percent of total billed charges,71% of total billed charges,493.12,67,,,percent of total billed charges,67% of total billed charges,493.12,67,,,percent of total billed charges,67% of total billed charges,522.56,71,,,percent of total billed charges,71% of total billed charges,559.36,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,242.59,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,662.4,90,,,percent of total billed charges,90% of total billed charges,662.4,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,652.1,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,235.52,32,,,percent of total billed charges,32% of total billed charges,588.8,80,,,percent of total billed charges,80% of total billed charges,588.8,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,669.76,91,,,percent of total billed charges,91% of total billed charges,240.23,32.64,,,percent of total billed charges,32.64% of total billed charges,235.52,32,,,percent of total billed charges,32% of total billed charges,247.3,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,235.52,32,,,percent of total billed charges,32% of total billed charges,235.52,32,,,percent of total billed charges,32% of total billed charges,677.12,92,,,percent of total billed charges,92% of total billed charges,217.67,677.12,
ECHO DOPPLER COMPLETE,5000018,CDM,483,RC,93320,HCPCS,Outpatient,,,435,369.75,,353.22,81.2,,,percent of total billed charges,81.2% of total billed charges,141.98,32.64,,,percent of total billed charges,32.64% of total billed charges,321.9,74,,,percent of total billed charges,74% of total billed charges,321.9,74,,,percent of total billed charges,74% of total billed charges,139.2,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,139.2,32,,,percent of total billed charges,32% of total billed charges,308.85,71,,,percent of total billed charges,71% of total billed charges,308.85,71,,,percent of total billed charges,71% of total billed charges,291.45,67,,,percent of total billed charges,67% of total billed charges,291.45,67,,,percent of total billed charges,67% of total billed charges,308.85,71,,,percent of total billed charges,71% of total billed charges,330.6,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,143.38,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,391.5,90,,,percent of total billed charges,90% of total billed charges,391.5,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,385.41,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,139.2,32,,,percent of total billed charges,32% of total billed charges,348,80,,,percent of total billed charges,80% of total billed charges,348,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,395.85,91,,,percent of total billed charges,91% of total billed charges,141.98,32.64,,,percent of total billed charges,32.64% of total billed charges,139.2,32,,,percent of total billed charges,32% of total billed charges,146.16,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,139.2,32,,,percent of total billed charges,32% of total billed charges,139.2,32,,,percent of total billed charges,32% of total billed charges,400.2,92,,,percent of total billed charges,92% of total billed charges,139.2,400.2,
ECHO DOPPLER LMTD OR F/U,5000031,CDM,483,RC,93321,HCPCS,Outpatient,,,365,310.25,,296.38,81.2,,,percent of total billed charges,81.2% of total billed charges,119.14,32.64,,,percent of total billed charges,32.64% of total billed charges,270.1,74,,,percent of total billed charges,74% of total billed charges,270.1,74,,,percent of total billed charges,74% of total billed charges,116.8,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,116.8,32,,,percent of total billed charges,32% of total billed charges,259.15,71,,,percent of total billed charges,71% of total billed charges,259.15,71,,,percent of total billed charges,71% of total billed charges,244.55,67,,,percent of total billed charges,67% of total billed charges,244.55,67,,,percent of total billed charges,67% of total billed charges,259.15,71,,,percent of total billed charges,71% of total billed charges,277.4,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,120.3,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,328.5,90,,,percent of total billed charges,90% of total billed charges,328.5,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,323.39,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,116.8,32,,,percent of total billed charges,32% of total billed charges,292,80,,,percent of total billed charges,80% of total billed charges,292,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,332.15,91,,,percent of total billed charges,91% of total billed charges,119.14,32.64,,,percent of total billed charges,32.64% of total billed charges,116.8,32,,,percent of total billed charges,32% of total billed charges,122.64,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,116.8,32,,,percent of total billed charges,32% of total billed charges,116.8,32,,,percent of total billed charges,32% of total billed charges,335.8,92,,,percent of total billed charges,92% of total billed charges,116.8,335.8,
ECHO DOPPLER COLOR FLOW,5000019,CDM,483,RC,93325,HCPCS,Outpatient,,,353,300.05,,286.64,81.2,,,percent of total billed charges,81.2% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,268.28,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,116.35,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,312.76,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,321.23,91,,,percent of total billed charges,91% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,118.61,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,324.76,92,,,percent of total billed charges,92% of total billed charges,60.19,324.76,
ECHO TTE STRESS,5000027,CDM,483,RC,93350,HCPCS,Outpatient,,,1393,1184.05,,1131.12,81.2,,,percent of total billed charges,81.2% of total billed charges,454.68,32.64,,,percent of total billed charges,32.64% of total billed charges,1030.82,74,,,percent of total billed charges,74% of total billed charges,1030.82,74,,,percent of total billed charges,74% of total billed charges,445.76,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,445.76,32,,,percent of total billed charges,32% of total billed charges,989.03,71,,,percent of total billed charges,71% of total billed charges,989.03,71,,,percent of total billed charges,71% of total billed charges,933.31,67,,,percent of total billed charges,67% of total billed charges,933.31,67,,,percent of total billed charges,67% of total billed charges,989.03,71,,,percent of total billed charges,71% of total billed charges,1058.68,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,459.13,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,1253.7,90,,,percent of total billed charges,90% of total billed charges,1253.7,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1234.2,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,445.76,32,,,percent of total billed charges,32% of total billed charges,1114.4,80,,,percent of total billed charges,80% of total billed charges,1114.4,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1267.63,91,,,percent of total billed charges,91% of total billed charges,454.68,32.64,,,percent of total billed charges,32.64% of total billed charges,445.76,32,,,percent of total billed charges,32% of total billed charges,468.05,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,445.76,32,,,percent of total billed charges,32% of total billed charges,445.76,32,,,percent of total billed charges,32% of total billed charges,1281.56,92,,,percent of total billed charges,92% of total billed charges,217.67,1281.56,
ECHO TTE STRESS W/ CONTRAST,5000046,CDM,483,RC,93350,HCPCS,Outpatient,,,1393,1184.05,,1131.12,81.2,,,percent of total billed charges,81.2% of total billed charges,454.68,32.64,,,percent of total billed charges,32.64% of total billed charges,1030.82,74,,,percent of total billed charges,74% of total billed charges,1030.82,74,,,percent of total billed charges,74% of total billed charges,445.76,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,445.76,32,,,percent of total billed charges,32% of total billed charges,989.03,71,,,percent of total billed charges,71% of total billed charges,989.03,71,,,percent of total billed charges,71% of total billed charges,933.31,67,,,percent of total billed charges,67% of total billed charges,933.31,67,,,percent of total billed charges,67% of total billed charges,989.03,71,,,percent of total billed charges,71% of total billed charges,1058.68,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,459.13,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,1253.7,90,,,percent of total billed charges,90% of total billed charges,1253.7,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1234.2,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,445.76,32,,,percent of total billed charges,32% of total billed charges,1114.4,80,,,percent of total billed charges,80% of total billed charges,1114.4,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,1267.63,91,,,percent of total billed charges,91% of total billed charges,454.68,32.64,,,percent of total billed charges,32.64% of total billed charges,445.76,32,,,percent of total billed charges,32% of total billed charges,468.05,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,445.76,32,,,percent of total billed charges,32% of total billed charges,445.76,32,,,percent of total billed charges,32% of total billed charges,1281.56,92,,,percent of total billed charges,92% of total billed charges,217.67,1281.56,
ECHO MYOCARDIAL STRAIN IMAGING,5000054,CDM,483,RC,93356,HCPCS,Outpatient,,,353,300.05,,286.64,81.2,,,percent of total billed charges,81.2% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,268.28,76,,,percent of total billed charges,76% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,116.35,32.96,,,percent of total billed charges,32.96% of total billed charges,228.56,105,,,Fee Schedule,pays based on EAPG rates,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,312.76,88.6,,,percent of total billed charges,88.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,217.67,100,,,Fee Schedule,pays based on EAPG rates,321.23,91,,,percent of total billed charges,91% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,118.61,33.6,,,percent of total billed charges,33.6% of total billed charges,224.2,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,324.76,92,,,percent of total billed charges,92% of total billed charges,112.96,324.76,
DUPLX EXTRACRN ART COMPLT BILAT,5000002,CDM,921,RC,93880,HCPCS,Outpatient,,,979,832.15,,794.95,81.2,,,percent of total billed charges,81.2% of total billed charges,319.55,32.64,,,percent of total billed charges,32.64% of total billed charges,724.46,74,,,percent of total billed charges,74% of total billed charges,724.46,74,,,percent of total billed charges,74% of total billed charges,313.28,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,313.28,32,,,percent of total billed charges,32% of total billed charges,695.09,71,,,percent of total billed charges,71% of total billed charges,695.09,71,,,percent of total billed charges,71% of total billed charges,655.93,67,,,percent of total billed charges,67% of total billed charges,655.93,67,,,percent of total billed charges,67% of total billed charges,695.09,71,,,percent of total billed charges,71% of total billed charges,744.04,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,322.68,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,867.39,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,313.28,32,,,percent of total billed charges,32% of total billed charges,783.2,80,,,percent of total billed charges,80% of total billed charges,783.2,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,890.89,91,,,percent of total billed charges,91% of total billed charges,319.55,32.64,,,percent of total billed charges,32.64% of total billed charges,313.28,32,,,percent of total billed charges,32% of total billed charges,328.94,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,313.28,32,,,percent of total billed charges,32% of total billed charges,313.28,32,,,percent of total billed charges,32% of total billed charges,900.68,92,,,percent of total billed charges,92% of total billed charges,60.19,900.68,
NPS EXT ARTS LMTD BILAT 1-2 LVLS/ABI,5000048,CDM,920,RC,93922,HCPCS,Outpatient,,,463,393.55,,375.96,81.2,,,percent of total billed charges,81.2% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,351.88,76,,,percent of total billed charges,76% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,152.6,32.96,,,percent of total billed charges,32.96% of total billed charges,70.21,105,,,Fee Schedule,pays based on EAPG rates,416.7,90,,,percent of total billed charges,90% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,66.87,100,,,Fee Schedule,pays based on EAPG rates,410.22,88.6,,,percent of total billed charges,88.6% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,66.87,100,,,Fee Schedule,pays based on EAPG rates,421.33,91,,,percent of total billed charges,91% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,155.57,33.6,,,percent of total billed charges,33.6% of total billed charges,68.87,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,425.96,92,,,percent of total billed charges,92% of total billed charges,66.87,425.96,
DUPLX LOW EXT ARTS COMPLT BILAT,5000006,CDM,921,RC,93925,HCPCS,Outpatient,,,827,702.95,,671.52,81.2,,,percent of total billed charges,81.2% of total billed charges,269.93,32.64,,,percent of total billed charges,32.64% of total billed charges,611.98,74,,,percent of total billed charges,74% of total billed charges,611.98,74,,,percent of total billed charges,74% of total billed charges,264.64,32,,,percent of total billed charges,32% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,264.64,32,,,percent of total billed charges,32% of total billed charges,587.17,71,,,percent of total billed charges,71% of total billed charges,587.17,71,,,percent of total billed charges,71% of total billed charges,554.09,67,,,percent of total billed charges,67% of total billed charges,554.09,67,,,percent of total billed charges,67% of total billed charges,587.17,71,,,percent of total billed charges,71% of total billed charges,628.52,76,,,percent of total billed charges,76% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,272.58,32.96,,,percent of total billed charges,32.96% of total billed charges,97.2,105,,,Fee Schedule,pays based on EAPG rates,744.3,90,,,percent of total billed charges,90% of total billed charges,744.3,90,,,percent of total billed charges,90% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,732.72,88.6,,,percent of total billed charges,88.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,264.64,32,,,percent of total billed charges,32% of total billed charges,661.6,80,,,percent of total billed charges,80% of total billed charges,661.6,80,,,percent of total billed charges,80% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,752.57,91,,,percent of total billed charges,91% of total billed charges,269.93,32.64,,,percent of total billed charges,32.64% of total billed charges,264.64,32,,,percent of total billed charges,32% of total billed charges,277.87,33.6,,,percent of total billed charges,33.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,264.64,32,,,percent of total billed charges,32% of total billed charges,264.64,32,,,percent of total billed charges,32% of total billed charges,760.84,92,,,percent of total billed charges,92% of total billed charges,92.57,760.84,
DUPLX LOW EXT ARTS LMTD/UNILAT LT,5000039,CDM,920,RC,93926,HCPCS,Outpatient,,,331,281.35,,268.77,81.2,,,percent of total billed charges,81.2% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,251.56,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,109.1,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,293.27,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,301.21,91,,,percent of total billed charges,91% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,111.22,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,304.52,92,,,percent of total billed charges,92% of total billed charges,60.19,304.52,
DUPLX LOW EXT ARTS LMTD/UNILAT RT,5000040,CDM,920,RC,93926,HCPCS,Outpatient,,,331,281.35,,268.77,81.2,,,percent of total billed charges,81.2% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,244.94,74,,,percent of total billed charges,74% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,221.77,67,,,percent of total billed charges,67% of total billed charges,235.01,71,,,percent of total billed charges,71% of total billed charges,251.56,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,109.1,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,293.27,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,264.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,301.21,91,,,percent of total billed charges,91% of total billed charges,108.04,32.64,,,percent of total billed charges,32.64% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,111.22,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,105.92,32,,,percent of total billed charges,32% of total billed charges,105.92,32,,,percent of total billed charges,32% of total billed charges,304.52,92,,,percent of total billed charges,92% of total billed charges,60.19,304.52,
DUPLX LOW EXT ARTS LMTD STUDY BILAT,5000053,CDM,920,RC,93926,HCPCS,Outpatient,,,496,421.6,,402.75,81.2,,,percent of total billed charges,81.2% of total billed charges,161.89,32.64,,,percent of total billed charges,32.64% of total billed charges,367.04,74,,,percent of total billed charges,74% of total billed charges,367.04,74,,,percent of total billed charges,74% of total billed charges,158.72,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,158.72,32,,,percent of total billed charges,32% of total billed charges,352.16,71,,,percent of total billed charges,71% of total billed charges,352.16,71,,,percent of total billed charges,71% of total billed charges,332.32,67,,,percent of total billed charges,67% of total billed charges,332.32,67,,,percent of total billed charges,67% of total billed charges,352.16,71,,,percent of total billed charges,71% of total billed charges,376.96,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,163.48,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,446.4,90,,,percent of total billed charges,90% of total billed charges,446.4,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,439.46,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,158.72,32,,,percent of total billed charges,32% of total billed charges,396.8,80,,,percent of total billed charges,80% of total billed charges,396.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,451.36,91,,,percent of total billed charges,91% of total billed charges,161.89,32.64,,,percent of total billed charges,32.64% of total billed charges,158.72,32,,,percent of total billed charges,32% of total billed charges,166.66,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,158.72,32,,,percent of total billed charges,32% of total billed charges,158.72,32,,,percent of total billed charges,32% of total billed charges,456.32,92,,,percent of total billed charges,92% of total billed charges,60.19,456.32,
DUPLX UP EXT ART CMPLT BILAT,5000012,CDM,920,RC,93930,HCPCS,Outpatient,,,463,393.55,,375.96,81.2,,,percent of total billed charges,81.2% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,351.88,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,152.6,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,416.7,90,,,percent of total billed charges,90% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,410.22,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,421.33,91,,,percent of total billed charges,91% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,155.57,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,425.96,92,,,percent of total billed charges,92% of total billed charges,60.19,425.96,
DUPLX UP EXT ARTS LMTD/UNILAT LT,5000033,CDM,920,RC,93931,HCPCS,Outpatient,,,508,431.8,,412.5,81.2,,,percent of total billed charges,81.2% of total billed charges,165.81,32.64,,,percent of total billed charges,32.64% of total billed charges,375.92,74,,,percent of total billed charges,74% of total billed charges,375.92,74,,,percent of total billed charges,74% of total billed charges,162.56,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,162.56,32,,,percent of total billed charges,32% of total billed charges,360.68,71,,,percent of total billed charges,71% of total billed charges,360.68,71,,,percent of total billed charges,71% of total billed charges,340.36,67,,,percent of total billed charges,67% of total billed charges,340.36,67,,,percent of total billed charges,67% of total billed charges,360.68,71,,,percent of total billed charges,71% of total billed charges,386.08,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,167.44,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,457.2,90,,,percent of total billed charges,90% of total billed charges,457.2,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,450.09,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,162.56,32,,,percent of total billed charges,32% of total billed charges,406.4,80,,,percent of total billed charges,80% of total billed charges,406.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,462.28,91,,,percent of total billed charges,91% of total billed charges,165.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.56,32,,,percent of total billed charges,32% of total billed charges,170.69,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,162.56,32,,,percent of total billed charges,32% of total billed charges,162.56,32,,,percent of total billed charges,32% of total billed charges,467.36,92,,,percent of total billed charges,92% of total billed charges,60.19,467.36,
DUPLX UP EXT ARTS LMTD/UNILAT RT,5000034,CDM,920,RC,93931,HCPCS,Outpatient,,,508,431.8,,412.5,81.2,,,percent of total billed charges,81.2% of total billed charges,165.81,32.64,,,percent of total billed charges,32.64% of total billed charges,375.92,74,,,percent of total billed charges,74% of total billed charges,375.92,74,,,percent of total billed charges,74% of total billed charges,162.56,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,162.56,32,,,percent of total billed charges,32% of total billed charges,360.68,71,,,percent of total billed charges,71% of total billed charges,360.68,71,,,percent of total billed charges,71% of total billed charges,340.36,67,,,percent of total billed charges,67% of total billed charges,340.36,67,,,percent of total billed charges,67% of total billed charges,360.68,71,,,percent of total billed charges,71% of total billed charges,386.08,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,167.44,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,457.2,90,,,percent of total billed charges,90% of total billed charges,457.2,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,450.09,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,162.56,32,,,percent of total billed charges,32% of total billed charges,406.4,80,,,percent of total billed charges,80% of total billed charges,406.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,462.28,91,,,percent of total billed charges,91% of total billed charges,165.81,32.64,,,percent of total billed charges,32.64% of total billed charges,162.56,32,,,percent of total billed charges,32% of total billed charges,170.69,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,162.56,32,,,percent of total billed charges,32% of total billed charges,162.56,32,,,percent of total billed charges,32% of total billed charges,467.36,92,,,percent of total billed charges,92% of total billed charges,60.19,467.36,
DUPLX VEIN COMPLT BILAT,5000009,CDM,921,RC,93970,HCPCS,Outpatient,,,463,393.55,,375.96,81.2,,,percent of total billed charges,81.2% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,351.88,76,,,percent of total billed charges,76% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,152.6,32.96,,,percent of total billed charges,32.96% of total billed charges,97.2,105,,,Fee Schedule,pays based on EAPG rates,416.7,90,,,percent of total billed charges,90% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,410.22,88.6,,,percent of total billed charges,88.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,421.33,91,,,percent of total billed charges,91% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,155.57,33.6,,,percent of total billed charges,33.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,425.96,92,,,percent of total billed charges,92% of total billed charges,92.57,425.96,
DUPLX VEIN LMTD/UNILAT LT,5000035,CDM,921,RC,93971,HCPCS,Outpatient,,,463,393.55,,375.96,81.2,,,percent of total billed charges,81.2% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,351.88,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,152.6,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,416.7,90,,,percent of total billed charges,90% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,410.22,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,421.33,91,,,percent of total billed charges,91% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,155.57,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,425.96,92,,,percent of total billed charges,92% of total billed charges,60.19,425.96,
DUPLX VEIN LMTD/UNILAT RT,5000036,CDM,921,RC,93971,HCPCS,Outpatient,,,463,393.55,,375.96,81.2,,,percent of total billed charges,81.2% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,342.62,74,,,percent of total billed charges,74% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,310.21,67,,,percent of total billed charges,67% of total billed charges,328.73,71,,,percent of total billed charges,71% of total billed charges,351.88,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,152.6,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,416.7,90,,,percent of total billed charges,90% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,410.22,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,370.4,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,421.33,91,,,percent of total billed charges,91% of total billed charges,151.12,32.64,,,percent of total billed charges,32.64% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,155.57,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,148.16,32,,,percent of total billed charges,32% of total billed charges,148.16,32,,,percent of total billed charges,32% of total billed charges,425.96,92,,,percent of total billed charges,92% of total billed charges,60.19,425.96,
DUPLX ART/IN VEIN/OUT COMPLETE STUDY,5000032,CDM,921,RC,93975,HCPCS,Outpatient,,,290,246.5,,235.48,81.2,,,percent of total billed charges,81.2% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,220.4,76,,,percent of total billed charges,76% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,95.58,32.96,,,percent of total billed charges,32.96% of total billed charges,97.2,105,,,Fee Schedule,pays based on EAPG rates,261,90,,,percent of total billed charges,90% of total billed charges,261,90,,,percent of total billed charges,90% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,256.94,88.6,,,percent of total billed charges,88.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,263.9,91,,,percent of total billed charges,91% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,97.44,33.6,,,percent of total billed charges,33.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,266.8,92,,,percent of total billed charges,92% of total billed charges,92.57,266.8,
DUPLX AORTA/IVC/ILIAC CMPLT STUDY,5000026,CDM,921,RC,93978,HCPCS,Outpatient,,,610,518.5,,495.32,81.2,,,percent of total billed charges,81.2% of total billed charges,199.1,32.64,,,percent of total billed charges,32.64% of total billed charges,451.4,74,,,percent of total billed charges,74% of total billed charges,451.4,74,,,percent of total billed charges,74% of total billed charges,195.2,32,,,percent of total billed charges,32% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,195.2,32,,,percent of total billed charges,32% of total billed charges,433.1,71,,,percent of total billed charges,71% of total billed charges,433.1,71,,,percent of total billed charges,71% of total billed charges,408.7,67,,,percent of total billed charges,67% of total billed charges,408.7,67,,,percent of total billed charges,67% of total billed charges,433.1,71,,,percent of total billed charges,71% of total billed charges,463.6,76,,,percent of total billed charges,76% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,201.06,32.96,,,percent of total billed charges,32.96% of total billed charges,97.2,105,,,Fee Schedule,pays based on EAPG rates,549,90,,,percent of total billed charges,90% of total billed charges,549,90,,,percent of total billed charges,90% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,540.46,88.6,,,percent of total billed charges,88.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,195.2,32,,,percent of total billed charges,32% of total billed charges,488,80,,,percent of total billed charges,80% of total billed charges,488,80,,,percent of total billed charges,80% of total billed charges,92.57,100,,,Fee Schedule,pays based on EAPG rates,555.1,91,,,percent of total billed charges,91% of total billed charges,199.1,32.64,,,percent of total billed charges,32.64% of total billed charges,195.2,32,,,percent of total billed charges,32% of total billed charges,204.96,33.6,,,percent of total billed charges,33.6% of total billed charges,95.34,103,,,Fee Schedule,pays based on EAPG rates,195.2,32,,,percent of total billed charges,32% of total billed charges,195.2,32,,,percent of total billed charges,32% of total billed charges,561.2,92,,,percent of total billed charges,92% of total billed charges,92.57,561.2,
DUPLX AORTA/IVC/ILIAC LMTD STUDY,5000007,CDM,921,RC,93979,HCPCS,Outpatient,,,431,366.35,,349.97,81.2,,,percent of total billed charges,81.2% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,318.94,74,,,percent of total billed charges,74% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,288.77,67,,,percent of total billed charges,67% of total billed charges,306.01,71,,,percent of total billed charges,71% of total billed charges,327.56,76,,,percent of total billed charges,76% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,142.06,32.96,,,percent of total billed charges,32.96% of total billed charges,63.2,105,,,Fee Schedule,pays based on EAPG rates,387.9,90,,,percent of total billed charges,90% of total billed charges,387.9,90,,,percent of total billed charges,90% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,381.87,88.6,,,percent of total billed charges,88.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,344.8,80,,,percent of total billed charges,80% of total billed charges,60.19,100,,,Fee Schedule,pays based on EAPG rates,392.21,91,,,percent of total billed charges,91% of total billed charges,140.68,32.64,,,percent of total billed charges,32.64% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,144.82,33.6,,,percent of total billed charges,33.6% of total billed charges,61.99,103,,,Fee Schedule,pays based on EAPG rates,137.92,32,,,percent of total billed charges,32% of total billed charges,137.92,32,,,percent of total billed charges,32% of total billed charges,396.52,92,,,percent of total billed charges,92% of total billed charges,60.19,396.52,
DEFINITY CONTRAST,5000047,CDM,255,RC,Q9957,HCPCS,Outpatient,,,436,370.6,,354.03,81.2,,,percent of total billed charges,81.2% of total billed charges,142.31,32.64,,,percent of total billed charges,32.64% of total billed charges,322.64,74,,,percent of total billed charges,74% of total billed charges,322.64,74,,,percent of total billed charges,74% of total billed charges,139.52,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,139.52,32,,,percent of total billed charges,32% of total billed charges,309.56,71,,,percent of total billed charges,71% of total billed charges,309.56,71,,,percent of total billed charges,71% of total billed charges,292.12,67,,,percent of total billed charges,67% of total billed charges,292.12,67,,,percent of total billed charges,67% of total billed charges,309.56,71,,,percent of total billed charges,71% of total billed charges,331.36,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,143.71,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,392.4,90,,,percent of total billed charges,90% of total billed charges,392.4,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,386.3,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,139.52,32,,,percent of total billed charges,32% of total billed charges,348.8,80,,,percent of total billed charges,80% of total billed charges,348.8,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,396.76,91,,,percent of total billed charges,91% of total billed charges,142.31,32.64,,,percent of total billed charges,32.64% of total billed charges,139.52,32,,,percent of total billed charges,32% of total billed charges,146.5,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,139.52,32,,,percent of total billed charges,32% of total billed charges,139.52,32,,,percent of total billed charges,32% of total billed charges,401.12,92,,,percent of total billed charges,92% of total billed charges,15.39,401.12,
LEVEL 2 NEW PATIENT,8600020,CDM,510,RC,99202,HCPCS,Outpatient,,,263,223.55,,213.56,81.2,,,percent of total billed charges,81.2% of total billed charges,85.84,32.64,,,percent of total billed charges,32.64% of total billed charges,194.62,74,,,percent of total billed charges,74% of total billed charges,194.62,74,,,percent of total billed charges,74% of total billed charges,84.16,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,84.16,32,,,percent of total billed charges,32% of total billed charges,186.73,71,,,percent of total billed charges,71% of total billed charges,186.73,71,,,percent of total billed charges,71% of total billed charges,176.21,67,,,percent of total billed charges,67% of total billed charges,176.21,67,,,percent of total billed charges,67% of total billed charges,186.73,71,,,percent of total billed charges,71% of total billed charges,199.88,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,86.68,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,233.02,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,84.16,32,,,percent of total billed charges,32% of total billed charges,210.4,80,,,percent of total billed charges,80% of total billed charges,210.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,239.33,91,,,percent of total billed charges,91% of total billed charges,85.84,32.64,,,percent of total billed charges,32.64% of total billed charges,84.16,32,,,percent of total billed charges,32% of total billed charges,88.37,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,84.16,32,,,percent of total billed charges,32% of total billed charges,84.16,32,,,percent of total billed charges,32% of total billed charges,241.96,92,,,percent of total billed charges,92% of total billed charges,42.34,241.96,
LEVEL 3 NEW PATIENT,8600021,CDM,510,RC,99203,HCPCS,Outpatient,,,394,334.9,,319.93,81.2,,,percent of total billed charges,81.2% of total billed charges,128.6,32.64,,,percent of total billed charges,32.64% of total billed charges,291.56,74,,,percent of total billed charges,74% of total billed charges,291.56,74,,,percent of total billed charges,74% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,263.98,67,,,percent of total billed charges,67% of total billed charges,263.98,67,,,percent of total billed charges,67% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,299.44,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,129.86,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,354.6,90,,,percent of total billed charges,90% of total billed charges,354.6,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,349.08,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,315.2,80,,,percent of total billed charges,80% of total billed charges,315.2,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,358.54,91,,,percent of total billed charges,91% of total billed charges,128.6,32.64,,,percent of total billed charges,32.64% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,132.38,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,362.48,92,,,percent of total billed charges,92% of total billed charges,42.34,362.48,
LEVEL 4 NEW PATIENT,8600022,CDM,510,RC,99204,HCPCS,Outpatient,,,506,430.1,,410.87,81.2,,,percent of total billed charges,81.2% of total billed charges,165.16,32.64,,,percent of total billed charges,32.64% of total billed charges,374.44,74,,,percent of total billed charges,74% of total billed charges,374.44,74,,,percent of total billed charges,74% of total billed charges,161.92,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,161.92,32,,,percent of total billed charges,32% of total billed charges,359.26,71,,,percent of total billed charges,71% of total billed charges,359.26,71,,,percent of total billed charges,71% of total billed charges,339.02,67,,,percent of total billed charges,67% of total billed charges,339.02,67,,,percent of total billed charges,67% of total billed charges,359.26,71,,,percent of total billed charges,71% of total billed charges,384.56,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,166.78,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,455.4,90,,,percent of total billed charges,90% of total billed charges,455.4,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,448.32,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,161.92,32,,,percent of total billed charges,32% of total billed charges,404.8,80,,,percent of total billed charges,80% of total billed charges,404.8,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,460.46,91,,,percent of total billed charges,91% of total billed charges,165.16,32.64,,,percent of total billed charges,32.64% of total billed charges,161.92,32,,,percent of total billed charges,32% of total billed charges,170.02,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,161.92,32,,,percent of total billed charges,32% of total billed charges,161.92,32,,,percent of total billed charges,32% of total billed charges,465.52,92,,,percent of total billed charges,92% of total billed charges,42.34,465.52,
LEVEL 5 NEW PATIENT,8600023,CDM,510,RC,99205,HCPCS,Outpatient,,,594,504.9,,482.33,81.2,,,percent of total billed charges,81.2% of total billed charges,193.88,32.64,,,percent of total billed charges,32.64% of total billed charges,439.56,74,,,percent of total billed charges,74% of total billed charges,439.56,74,,,percent of total billed charges,74% of total billed charges,190.08,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,190.08,32,,,percent of total billed charges,32% of total billed charges,421.74,71,,,percent of total billed charges,71% of total billed charges,421.74,71,,,percent of total billed charges,71% of total billed charges,397.98,67,,,percent of total billed charges,67% of total billed charges,397.98,67,,,percent of total billed charges,67% of total billed charges,421.74,71,,,percent of total billed charges,71% of total billed charges,451.44,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,195.78,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,534.6,90,,,percent of total billed charges,90% of total billed charges,534.6,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,526.28,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,190.08,32,,,percent of total billed charges,32% of total billed charges,475.2,80,,,percent of total billed charges,80% of total billed charges,475.2,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,540.54,91,,,percent of total billed charges,91% of total billed charges,193.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.08,32,,,percent of total billed charges,32% of total billed charges,199.58,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,190.08,32,,,percent of total billed charges,32% of total billed charges,190.08,32,,,percent of total billed charges,32% of total billed charges,546.48,92,,,percent of total billed charges,92% of total billed charges,42.34,546.48,
HISTORY & PHYSICAL PREOP,8600009,CDM,510,RC,99211,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,42.34,122.36,
LEVEL 1 ESTABLISHED PATIENT,8600012,CDM,510,RC,99211,HCPCS,Outpatient,,,133,113.05,,108,81.2,,,percent of total billed charges,81.2% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,98.42,74,,,percent of total billed charges,74% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,89.11,67,,,percent of total billed charges,67% of total billed charges,94.43,71,,,percent of total billed charges,71% of total billed charges,101.08,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,43.84,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,117.84,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,106.4,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,121.03,91,,,percent of total billed charges,91% of total billed charges,43.41,32.64,,,percent of total billed charges,32.64% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,44.69,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,42.56,32,,,percent of total billed charges,32% of total billed charges,42.56,32,,,percent of total billed charges,32% of total billed charges,122.36,92,,,percent of total billed charges,92% of total billed charges,42.34,122.36,
LEVEL 2 ESTABLISHED PATIENT,8600015,CDM,510,RC,99212,HCPCS,Outpatient,,,200,170,,162.4,81.2,,,percent of total billed charges,81.2% of total billed charges,65.28,32.64,,,percent of total billed charges,32.64% of total billed charges,148,74,,,percent of total billed charges,74% of total billed charges,148,74,,,percent of total billed charges,74% of total billed charges,64,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,64,32,,,percent of total billed charges,32% of total billed charges,142,71,,,percent of total billed charges,71% of total billed charges,142,71,,,percent of total billed charges,71% of total billed charges,134,67,,,percent of total billed charges,67% of total billed charges,134,67,,,percent of total billed charges,67% of total billed charges,142,71,,,percent of total billed charges,71% of total billed charges,152,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,65.92,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,177.2,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,64,32,,,percent of total billed charges,32% of total billed charges,160,80,,,percent of total billed charges,80% of total billed charges,160,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,182,91,,,percent of total billed charges,91% of total billed charges,65.28,32.64,,,percent of total billed charges,32.64% of total billed charges,64,32,,,percent of total billed charges,32% of total billed charges,67.2,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,64,32,,,percent of total billed charges,32% of total billed charges,64,32,,,percent of total billed charges,32% of total billed charges,184,92,,,percent of total billed charges,92% of total billed charges,42.34,184,
LEVEL 3 ESTABLISHED PATIENT,8600016,CDM,510,RC,99213,HCPCS,Outpatient,,,310,263.5,,251.72,81.2,,,percent of total billed charges,81.2% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,229.4,74,,,percent of total billed charges,74% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,207.7,67,,,percent of total billed charges,67% of total billed charges,220.1,71,,,percent of total billed charges,71% of total billed charges,235.6,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,102.18,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,274.66,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,248,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,282.1,91,,,percent of total billed charges,91% of total billed charges,101.18,32.64,,,percent of total billed charges,32.64% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,104.16,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,99.2,32,,,percent of total billed charges,32% of total billed charges,99.2,32,,,percent of total billed charges,32% of total billed charges,285.2,92,,,percent of total billed charges,92% of total billed charges,42.34,285.2,
LEVEL 4 ESTABLISHED PATIENT,8600017,CDM,510,RC,99214,HCPCS,Outpatient,,,394,334.9,,319.93,81.2,,,percent of total billed charges,81.2% of total billed charges,128.6,32.64,,,percent of total billed charges,32.64% of total billed charges,291.56,74,,,percent of total billed charges,74% of total billed charges,291.56,74,,,percent of total billed charges,74% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,263.98,67,,,percent of total billed charges,67% of total billed charges,263.98,67,,,percent of total billed charges,67% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,299.44,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,129.86,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,354.6,90,,,percent of total billed charges,90% of total billed charges,354.6,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,349.08,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,315.2,80,,,percent of total billed charges,80% of total billed charges,315.2,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,358.54,91,,,percent of total billed charges,91% of total billed charges,128.6,32.64,,,percent of total billed charges,32.64% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,132.38,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,362.48,92,,,percent of total billed charges,92% of total billed charges,42.34,362.48,
LEVEL 5 ESTABLISHED PATIENT,8600018,CDM,510,RC,99215,HCPCS,Outpatient,,,490,416.5,,397.88,81.2,,,percent of total billed charges,81.2% of total billed charges,159.94,32.64,,,percent of total billed charges,32.64% of total billed charges,362.6,74,,,percent of total billed charges,74% of total billed charges,362.6,74,,,percent of total billed charges,74% of total billed charges,156.8,32,,,percent of total billed charges,32% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,156.8,32,,,percent of total billed charges,32% of total billed charges,347.9,71,,,percent of total billed charges,71% of total billed charges,347.9,71,,,percent of total billed charges,71% of total billed charges,328.3,67,,,percent of total billed charges,67% of total billed charges,328.3,67,,,percent of total billed charges,67% of total billed charges,347.9,71,,,percent of total billed charges,71% of total billed charges,372.4,76,,,percent of total billed charges,76% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,161.5,32.96,,,percent of total billed charges,32.96% of total billed charges,44.45,105,,,Fee Schedule,pays based on EAPG rates,441,90,,,percent of total billed charges,90% of total billed charges,441,90,,,percent of total billed charges,90% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,434.14,88.6,,,percent of total billed charges,88.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,156.8,32,,,percent of total billed charges,32% of total billed charges,392,80,,,percent of total billed charges,80% of total billed charges,392,80,,,percent of total billed charges,80% of total billed charges,42.34,100,,,Fee Schedule,pays based on EAPG rates,445.9,91,,,percent of total billed charges,91% of total billed charges,159.94,32.64,,,percent of total billed charges,32.64% of total billed charges,156.8,32,,,percent of total billed charges,32% of total billed charges,164.64,33.6,,,percent of total billed charges,33.6% of total billed charges,43.61,103,,,Fee Schedule,pays based on EAPG rates,156.8,32,,,percent of total billed charges,32% of total billed charges,156.8,32,,,percent of total billed charges,32% of total billed charges,450.8,92,,,percent of total billed charges,92% of total billed charges,42.34,450.8,
HIP/SHOULDER/KNEE JOINT INJECTION LT,4000276,CDM,761,RC,20610,HCPCS,Outpatient,,,738,627.3,,599.26,81.2,,,percent of total billed charges,81.2% of total billed charges,240.88,32.64,,,percent of total billed charges,32.64% of total billed charges,546.12,74,,,percent of total billed charges,74% of total billed charges,546.12,74,,,percent of total billed charges,74% of total billed charges,236.16,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,236.16,32,,,percent of total billed charges,32% of total billed charges,523.98,71,,,percent of total billed charges,71% of total billed charges,523.98,71,,,percent of total billed charges,71% of total billed charges,494.46,67,,,percent of total billed charges,67% of total billed charges,494.46,67,,,percent of total billed charges,67% of total billed charges,523.98,71,,,percent of total billed charges,71% of total billed charges,560.88,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,243.24,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,664.2,90,,,percent of total billed charges,90% of total billed charges,664.2,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,653.87,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,236.16,32,,,percent of total billed charges,32% of total billed charges,590.4,80,,,percent of total billed charges,80% of total billed charges,590.4,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,671.58,91,,,percent of total billed charges,91% of total billed charges,240.88,32.64,,,percent of total billed charges,32.64% of total billed charges,236.16,32,,,percent of total billed charges,32% of total billed charges,247.97,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,236.16,32,,,percent of total billed charges,32% of total billed charges,236.16,32,,,percent of total billed charges,32% of total billed charges,678.96,92,,,percent of total billed charges,92% of total billed charges,107.66,678.96,
HIP/SHOULDER/KNEE JOINT INJECTION RT,4000315,CDM,761,RC,20610,HCPCS,Outpatient,,,738,627.3,,599.26,81.2,,,percent of total billed charges,81.2% of total billed charges,240.88,32.64,,,percent of total billed charges,32.64% of total billed charges,546.12,74,,,percent of total billed charges,74% of total billed charges,546.12,74,,,percent of total billed charges,74% of total billed charges,236.16,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,236.16,32,,,percent of total billed charges,32% of total billed charges,523.98,71,,,percent of total billed charges,71% of total billed charges,523.98,71,,,percent of total billed charges,71% of total billed charges,494.46,67,,,percent of total billed charges,67% of total billed charges,494.46,67,,,percent of total billed charges,67% of total billed charges,523.98,71,,,percent of total billed charges,71% of total billed charges,560.88,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,243.24,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,664.2,90,,,percent of total billed charges,90% of total billed charges,664.2,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,653.87,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,236.16,32,,,percent of total billed charges,32% of total billed charges,590.4,80,,,percent of total billed charges,80% of total billed charges,590.4,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,671.58,91,,,percent of total billed charges,91% of total billed charges,240.88,32.64,,,percent of total billed charges,32.64% of total billed charges,236.16,32,,,percent of total billed charges,32% of total billed charges,247.97,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,236.16,32,,,percent of total billed charges,32% of total billed charges,236.16,32,,,percent of total billed charges,32% of total billed charges,678.96,92,,,percent of total billed charges,92% of total billed charges,107.66,678.96,
HIP/SHOULDER/KNEE JOINT INJECTION BILAT,4000316,CDM,761,RC,20610,HCPCS,Outpatient,,,755,641.75,,613.06,81.2,,,percent of total billed charges,81.2% of total billed charges,246.43,32.64,,,percent of total billed charges,32.64% of total billed charges,558.7,74,,,percent of total billed charges,74% of total billed charges,558.7,74,,,percent of total billed charges,74% of total billed charges,241.6,32,,,percent of total billed charges,32% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,241.6,32,,,percent of total billed charges,32% of total billed charges,536.05,71,,,percent of total billed charges,71% of total billed charges,536.05,71,,,percent of total billed charges,71% of total billed charges,505.85,67,,,percent of total billed charges,67% of total billed charges,505.85,67,,,percent of total billed charges,67% of total billed charges,536.05,71,,,percent of total billed charges,71% of total billed charges,573.8,76,,,percent of total billed charges,76% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,248.85,32.96,,,percent of total billed charges,32.96% of total billed charges,113.04,105,,,Fee Schedule,pays based on EAPG rates,679.5,90,,,percent of total billed charges,90% of total billed charges,679.5,90,,,percent of total billed charges,90% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,668.93,88.6,,,percent of total billed charges,88.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,241.6,32,,,percent of total billed charges,32% of total billed charges,604,80,,,percent of total billed charges,80% of total billed charges,604,80,,,percent of total billed charges,80% of total billed charges,107.66,100,,,Fee Schedule,pays based on EAPG rates,687.05,91,,,percent of total billed charges,91% of total billed charges,246.43,32.64,,,percent of total billed charges,32.64% of total billed charges,241.6,32,,,percent of total billed charges,32% of total billed charges,253.68,33.6,,,percent of total billed charges,33.6% of total billed charges,110.89,103,,,Fee Schedule,pays based on EAPG rates,241.6,32,,,percent of total billed charges,32% of total billed charges,241.6,32,,,percent of total billed charges,32% of total billed charges,694.6,92,,,percent of total billed charges,92% of total billed charges,107.66,694.6,
ARTHRO INJ SHOULDER LT,4000359,CDM,320,RC,23350,HCPCS,Outpatient,,,183,155.55,,148.6,81.2,,,percent of total billed charges,81.2% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,139.08,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,60.32,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,164.7,90,,,percent of total billed charges,90% of total billed charges,164.7,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,162.14,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,166.53,91,,,percent of total billed charges,91% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,61.49,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,168.36,92,,,percent of total billed charges,92% of total billed charges,50.51,168.36,
ARTHRO INJ SHOULDER RT,4000360,CDM,320,RC,23350,HCPCS,Outpatient,,,183,155.55,,148.6,81.2,,,percent of total billed charges,81.2% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,135.42,74,,,percent of total billed charges,74% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,122.61,67,,,percent of total billed charges,67% of total billed charges,129.93,71,,,percent of total billed charges,71% of total billed charges,139.08,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,60.32,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,164.7,90,,,percent of total billed charges,90% of total billed charges,164.7,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,162.14,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,146.4,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,166.53,91,,,percent of total billed charges,91% of total billed charges,59.73,32.64,,,percent of total billed charges,32.64% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,61.49,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,58.56,32,,,percent of total billed charges,32% of total billed charges,58.56,32,,,percent of total billed charges,32% of total billed charges,168.36,92,,,percent of total billed charges,92% of total billed charges,50.51,168.36,
ARTHRO INJ SHOULDER BILAT,4000361,CDM,320,RC,23350,HCPCS,Outpatient,,,276,234.6,,224.11,81.2,,,percent of total billed charges,81.2% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,209.76,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,90.97,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,248.4,90,,,percent of total billed charges,90% of total billed charges,248.4,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,244.54,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,251.16,91,,,percent of total billed charges,91% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,92.74,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,253.92,92,,,percent of total billed charges,92% of total billed charges,50.51,253.92,
ARTHRO INJ ELBOW LT,4000373,CDM,320,RC,24220,HCPCS,Outpatient,,,245,208.25,,198.94,81.2,,,percent of total billed charges,81.2% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,186.2,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,80.75,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,220.5,90,,,percent of total billed charges,90% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,217.07,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,222.95,91,,,percent of total billed charges,91% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,82.32,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,225.4,92,,,percent of total billed charges,92% of total billed charges,50.51,225.4,
ARTHRO INJ ELBOW RT,4000374,CDM,320,RC,24220,HCPCS,Outpatient,,,245,208.25,,198.94,81.2,,,percent of total billed charges,81.2% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,186.2,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,80.75,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,220.5,90,,,percent of total billed charges,90% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,217.07,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,222.95,91,,,percent of total billed charges,91% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,82.32,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,225.4,92,,,percent of total billed charges,92% of total billed charges,50.51,225.4,
ARTHRO INJ ELBOW BILAT,4000375,CDM,320,RC,24220,HCPCS,Outpatient,,,368,312.8,,298.82,81.2,,,percent of total billed charges,81.2% of total billed charges,120.12,32.64,,,percent of total billed charges,32.64% of total billed charges,272.32,74,,,percent of total billed charges,74% of total billed charges,272.32,74,,,percent of total billed charges,74% of total billed charges,117.76,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,117.76,32,,,percent of total billed charges,32% of total billed charges,261.28,71,,,percent of total billed charges,71% of total billed charges,261.28,71,,,percent of total billed charges,71% of total billed charges,246.56,67,,,percent of total billed charges,67% of total billed charges,246.56,67,,,percent of total billed charges,67% of total billed charges,261.28,71,,,percent of total billed charges,71% of total billed charges,279.68,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,121.29,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,331.2,90,,,percent of total billed charges,90% of total billed charges,331.2,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,326.05,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,117.76,32,,,percent of total billed charges,32% of total billed charges,294.4,80,,,percent of total billed charges,80% of total billed charges,294.4,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,334.88,91,,,percent of total billed charges,91% of total billed charges,120.12,32.64,,,percent of total billed charges,32.64% of total billed charges,117.76,32,,,percent of total billed charges,32% of total billed charges,123.65,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,117.76,32,,,percent of total billed charges,32% of total billed charges,117.76,32,,,percent of total billed charges,32% of total billed charges,338.56,92,,,percent of total billed charges,92% of total billed charges,50.51,338.56,
ARTHRO INJ WRIST LT,4000362,CDM,320,RC,25246,HCPCS,Outpatient,,,270,229.5,,219.24,81.2,,,percent of total billed charges,81.2% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,205.2,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,88.99,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,239.22,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,245.7,91,,,percent of total billed charges,91% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,90.72,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,248.4,92,,,percent of total billed charges,92% of total billed charges,50.51,248.4,
ARTHRO INJ WRIST RT,4000363,CDM,320,RC,25246,HCPCS,Outpatient,,,270,229.5,,219.24,81.2,,,percent of total billed charges,81.2% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,199.8,74,,,percent of total billed charges,74% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,180.9,67,,,percent of total billed charges,67% of total billed charges,191.7,71,,,percent of total billed charges,71% of total billed charges,205.2,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,88.99,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,239.22,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,216,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,245.7,91,,,percent of total billed charges,91% of total billed charges,88.13,32.64,,,percent of total billed charges,32.64% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,90.72,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,86.4,32,,,percent of total billed charges,32% of total billed charges,86.4,32,,,percent of total billed charges,32% of total billed charges,248.4,92,,,percent of total billed charges,92% of total billed charges,50.51,248.4,
ARTHRO INJ WRIST BILAT,4000366,CDM,320,RC,25246,HCPCS,Outpatient,,,404,343.4,,328.05,81.2,,,percent of total billed charges,81.2% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,298.96,74,,,percent of total billed charges,74% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,270.68,67,,,percent of total billed charges,67% of total billed charges,286.84,71,,,percent of total billed charges,71% of total billed charges,307.04,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,133.16,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,357.94,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,323.2,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,367.64,91,,,percent of total billed charges,91% of total billed charges,131.87,32.64,,,percent of total billed charges,32.64% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,135.74,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,129.28,32,,,percent of total billed charges,32% of total billed charges,129.28,32,,,percent of total billed charges,32% of total billed charges,371.68,92,,,percent of total billed charges,92% of total billed charges,50.51,371.68,
ARTHRO INJ HIP LT,4000367,CDM,320,RC,27093,HCPCS,Outpatient,,,251,213.35,,203.81,81.2,,,percent of total billed charges,81.2% of total billed charges,81.93,32.64,,,percent of total billed charges,32.64% of total billed charges,185.74,74,,,percent of total billed charges,74% of total billed charges,185.74,74,,,percent of total billed charges,74% of total billed charges,80.32,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,80.32,32,,,percent of total billed charges,32% of total billed charges,178.21,71,,,percent of total billed charges,71% of total billed charges,178.21,71,,,percent of total billed charges,71% of total billed charges,168.17,67,,,percent of total billed charges,67% of total billed charges,168.17,67,,,percent of total billed charges,67% of total billed charges,178.21,71,,,percent of total billed charges,71% of total billed charges,190.76,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,82.73,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,225.9,90,,,percent of total billed charges,90% of total billed charges,225.9,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,222.39,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,80.32,32,,,percent of total billed charges,32% of total billed charges,200.8,80,,,percent of total billed charges,80% of total billed charges,200.8,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,228.41,91,,,percent of total billed charges,91% of total billed charges,81.93,32.64,,,percent of total billed charges,32.64% of total billed charges,80.32,32,,,percent of total billed charges,32% of total billed charges,84.34,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,80.32,32,,,percent of total billed charges,32% of total billed charges,80.32,32,,,percent of total billed charges,32% of total billed charges,230.92,92,,,percent of total billed charges,92% of total billed charges,50.51,230.92,
ARTHRO INJ HIP RT,4000368,CDM,320,RC,27093,HCPCS,Outpatient,,,251,213.35,,203.81,81.2,,,percent of total billed charges,81.2% of total billed charges,81.93,32.64,,,percent of total billed charges,32.64% of total billed charges,185.74,74,,,percent of total billed charges,74% of total billed charges,185.74,74,,,percent of total billed charges,74% of total billed charges,80.32,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,80.32,32,,,percent of total billed charges,32% of total billed charges,178.21,71,,,percent of total billed charges,71% of total billed charges,178.21,71,,,percent of total billed charges,71% of total billed charges,168.17,67,,,percent of total billed charges,67% of total billed charges,168.17,67,,,percent of total billed charges,67% of total billed charges,178.21,71,,,percent of total billed charges,71% of total billed charges,190.76,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,82.73,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,225.9,90,,,percent of total billed charges,90% of total billed charges,225.9,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,222.39,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,80.32,32,,,percent of total billed charges,32% of total billed charges,200.8,80,,,percent of total billed charges,80% of total billed charges,200.8,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,228.41,91,,,percent of total billed charges,91% of total billed charges,81.93,32.64,,,percent of total billed charges,32.64% of total billed charges,80.32,32,,,percent of total billed charges,32% of total billed charges,84.34,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,80.32,32,,,percent of total billed charges,32% of total billed charges,80.32,32,,,percent of total billed charges,32% of total billed charges,230.92,92,,,percent of total billed charges,92% of total billed charges,50.51,230.92,
ARTHRO INJ HIP BILAT,4000369,CDM,320,RC,27093,HCPCS,Outpatient,,,366,311.1,,297.19,81.2,,,percent of total billed charges,81.2% of total billed charges,119.46,32.64,,,percent of total billed charges,32.64% of total billed charges,270.84,74,,,percent of total billed charges,74% of total billed charges,270.84,74,,,percent of total billed charges,74% of total billed charges,117.12,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,117.12,32,,,percent of total billed charges,32% of total billed charges,259.86,71,,,percent of total billed charges,71% of total billed charges,259.86,71,,,percent of total billed charges,71% of total billed charges,245.22,67,,,percent of total billed charges,67% of total billed charges,245.22,67,,,percent of total billed charges,67% of total billed charges,259.86,71,,,percent of total billed charges,71% of total billed charges,278.16,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,120.63,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,329.4,90,,,percent of total billed charges,90% of total billed charges,329.4,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,324.28,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,117.12,32,,,percent of total billed charges,32% of total billed charges,292.8,80,,,percent of total billed charges,80% of total billed charges,292.8,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,333.06,91,,,percent of total billed charges,91% of total billed charges,119.46,32.64,,,percent of total billed charges,32.64% of total billed charges,117.12,32,,,percent of total billed charges,32% of total billed charges,122.98,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,117.12,32,,,percent of total billed charges,32% of total billed charges,117.12,32,,,percent of total billed charges,32% of total billed charges,336.72,92,,,percent of total billed charges,92% of total billed charges,50.51,336.72,
ARTHRO INJ KNEE LT,4000370,CDM,320,RC,27369,HCPCS,Outpatient,,,181,153.85,,146.97,81.2,,,percent of total billed charges,81.2% of total billed charges,59.08,32.64,,,percent of total billed charges,32.64% of total billed charges,133.94,74,,,percent of total billed charges,74% of total billed charges,133.94,74,,,percent of total billed charges,74% of total billed charges,57.92,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,57.92,32,,,percent of total billed charges,32% of total billed charges,128.51,71,,,percent of total billed charges,71% of total billed charges,128.51,71,,,percent of total billed charges,71% of total billed charges,121.27,67,,,percent of total billed charges,67% of total billed charges,121.27,67,,,percent of total billed charges,67% of total billed charges,128.51,71,,,percent of total billed charges,71% of total billed charges,137.56,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,59.66,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,160.37,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,57.92,32,,,percent of total billed charges,32% of total billed charges,144.8,80,,,percent of total billed charges,80% of total billed charges,144.8,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,164.71,91,,,percent of total billed charges,91% of total billed charges,59.08,32.64,,,percent of total billed charges,32.64% of total billed charges,57.92,32,,,percent of total billed charges,32% of total billed charges,60.82,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,57.92,32,,,percent of total billed charges,32% of total billed charges,57.92,32,,,percent of total billed charges,32% of total billed charges,166.52,92,,,percent of total billed charges,92% of total billed charges,50.51,166.52,
ARTHRO INJ KNEE RT,4000371,CDM,320,RC,27369,HCPCS,Outpatient,,,181,153.85,,146.97,81.2,,,percent of total billed charges,81.2% of total billed charges,59.08,32.64,,,percent of total billed charges,32.64% of total billed charges,133.94,74,,,percent of total billed charges,74% of total billed charges,133.94,74,,,percent of total billed charges,74% of total billed charges,57.92,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,57.92,32,,,percent of total billed charges,32% of total billed charges,128.51,71,,,percent of total billed charges,71% of total billed charges,128.51,71,,,percent of total billed charges,71% of total billed charges,121.27,67,,,percent of total billed charges,67% of total billed charges,121.27,67,,,percent of total billed charges,67% of total billed charges,128.51,71,,,percent of total billed charges,71% of total billed charges,137.56,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,59.66,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,160.37,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,57.92,32,,,percent of total billed charges,32% of total billed charges,144.8,80,,,percent of total billed charges,80% of total billed charges,144.8,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,164.71,91,,,percent of total billed charges,91% of total billed charges,59.08,32.64,,,percent of total billed charges,32.64% of total billed charges,57.92,32,,,percent of total billed charges,32% of total billed charges,60.82,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,57.92,32,,,percent of total billed charges,32% of total billed charges,57.92,32,,,percent of total billed charges,32% of total billed charges,166.52,92,,,percent of total billed charges,92% of total billed charges,50.51,166.52,
ARTHRO INJ KNEE BILAT,4000372,CDM,320,RC,27369,HCPCS,Outpatient,,,273,232.05,,221.68,81.2,,,percent of total billed charges,81.2% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,202.02,74,,,percent of total billed charges,74% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,182.91,67,,,percent of total billed charges,67% of total billed charges,193.83,71,,,percent of total billed charges,71% of total billed charges,207.48,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,89.98,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,245.7,90,,,percent of total billed charges,90% of total billed charges,245.7,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,241.88,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,218.4,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,248.43,91,,,percent of total billed charges,91% of total billed charges,89.11,32.64,,,percent of total billed charges,32.64% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,91.73,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,87.36,32,,,percent of total billed charges,32% of total billed charges,87.36,32,,,percent of total billed charges,32% of total billed charges,251.16,92,,,percent of total billed charges,92% of total billed charges,50.51,251.16,
FLUORO CONTRAST INJ PORT,4000329,CDM,761,RC,36598,HCPCS,Outpatient,,,735,624.75,,596.82,81.2,,,percent of total billed charges,81.2% of total billed charges,239.9,32.64,,,percent of total billed charges,32.64% of total billed charges,543.9,74,,,percent of total billed charges,74% of total billed charges,543.9,74,,,percent of total billed charges,74% of total billed charges,235.2,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,235.2,32,,,percent of total billed charges,32% of total billed charges,521.85,71,,,percent of total billed charges,71% of total billed charges,521.85,71,,,percent of total billed charges,71% of total billed charges,492.45,67,,,percent of total billed charges,67% of total billed charges,492.45,67,,,percent of total billed charges,67% of total billed charges,521.85,71,,,percent of total billed charges,71% of total billed charges,558.6,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,242.26,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,661.5,90,,,percent of total billed charges,90% of total billed charges,661.5,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,651.21,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,235.2,32,,,percent of total billed charges,32% of total billed charges,588,80,,,percent of total billed charges,80% of total billed charges,588,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,668.85,91,,,percent of total billed charges,91% of total billed charges,239.9,32.64,,,percent of total billed charges,32.64% of total billed charges,235.2,32,,,percent of total billed charges,32% of total billed charges,246.96,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,235.2,32,,,percent of total billed charges,32% of total billed charges,235.2,32,,,percent of total billed charges,32% of total billed charges,676.2,92,,,percent of total billed charges,92% of total billed charges,50.51,676.2,
CHOL/T TUBE,4000214,CDM,320,RC,47531,HCPCS,Outpatient,,,353,300.05,,286.64,81.2,,,percent of total billed charges,81.2% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,261.22,74,,,percent of total billed charges,74% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,629.48,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,236.51,67,,,percent of total billed charges,67% of total billed charges,250.63,71,,,percent of total billed charges,71% of total billed charges,268.28,76,,,percent of total billed charges,76% of total billed charges,629.48,103,,,Fee Schedule,pays based on EAPG rates,116.35,32.96,,,percent of total billed charges,32.96% of total billed charges,641.7,105,,,Fee Schedule,pays based on EAPG rates,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,611.14,100,,,Fee Schedule,pays based on EAPG rates,312.76,88.6,,,percent of total billed charges,88.6% of total billed charges,629.48,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,282.4,80,,,percent of total billed charges,80% of total billed charges,611.14,100,,,Fee Schedule,pays based on EAPG rates,321.23,91,,,percent of total billed charges,91% of total billed charges,115.22,32.64,,,percent of total billed charges,32.64% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,118.61,33.6,,,percent of total billed charges,33.6% of total billed charges,629.48,103,,,Fee Schedule,pays based on EAPG rates,112.96,32,,,percent of total billed charges,32% of total billed charges,112.96,32,,,percent of total billed charges,32% of total billed charges,324.76,92,,,percent of total billed charges,92% of total billed charges,112.96,641.7,
INJ CYSTO/VOIDING URETHROCYSTO,4000396,CDM,320,RC,51600,HCPCS,Outpatient,,,993,844.05,,806.32,81.2,,,percent of total billed charges,81.2% of total billed charges,324.12,32.64,,,percent of total billed charges,32.64% of total billed charges,734.82,74,,,percent of total billed charges,74% of total billed charges,734.82,74,,,percent of total billed charges,74% of total billed charges,317.76,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,317.76,32,,,percent of total billed charges,32% of total billed charges,705.03,71,,,percent of total billed charges,71% of total billed charges,705.03,71,,,percent of total billed charges,71% of total billed charges,665.31,67,,,percent of total billed charges,67% of total billed charges,665.31,67,,,percent of total billed charges,67% of total billed charges,705.03,71,,,percent of total billed charges,71% of total billed charges,754.68,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,327.29,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,893.7,90,,,percent of total billed charges,90% of total billed charges,893.7,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,879.8,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,317.76,32,,,percent of total billed charges,32% of total billed charges,794.4,80,,,percent of total billed charges,80% of total billed charges,794.4,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,903.63,91,,,percent of total billed charges,91% of total billed charges,324.12,32.64,,,percent of total billed charges,32.64% of total billed charges,317.76,32,,,percent of total billed charges,32% of total billed charges,333.65,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,317.76,32,,,percent of total billed charges,32% of total billed charges,317.76,32,,,percent of total billed charges,32% of total billed charges,913.56,92,,,percent of total billed charges,92% of total billed charges,50.51,913.56,
INJ FOR HSG,4000397,CDM,320,RC,58340,HCPCS,Outpatient,,,149,126.65,,120.99,81.2,,,percent of total billed charges,81.2% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,110.26,74,,,percent of total billed charges,74% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,99.83,67,,,percent of total billed charges,67% of total billed charges,105.79,71,,,percent of total billed charges,71% of total billed charges,113.24,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,49.11,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,132.01,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,119.2,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,135.59,91,,,percent of total billed charges,91% of total billed charges,48.63,32.64,,,percent of total billed charges,32.64% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,50.06,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,47.68,32,,,percent of total billed charges,32% of total billed charges,47.68,32,,,percent of total billed charges,32% of total billed charges,137.08,92,,,percent of total billed charges,92% of total billed charges,47.68,137.08,
SPINAL PUNCTURE LMBR DX W/O FLUORO,4000228,CDM,320,RC,62270,HCPCS,Outpatient,,,1781,1513.85,,1446.17,81.2,,,percent of total billed charges,81.2% of total billed charges,581.32,32.64,,,percent of total billed charges,32.64% of total billed charges,1317.94,74,,,percent of total billed charges,74% of total billed charges,1317.94,74,,,percent of total billed charges,74% of total billed charges,569.92,32,,,percent of total billed charges,32% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,569.92,32,,,percent of total billed charges,32% of total billed charges,1264.51,71,,,percent of total billed charges,71% of total billed charges,1264.51,71,,,percent of total billed charges,71% of total billed charges,1193.27,67,,,percent of total billed charges,67% of total billed charges,1193.27,67,,,percent of total billed charges,67% of total billed charges,1264.51,71,,,percent of total billed charges,71% of total billed charges,1353.56,76,,,percent of total billed charges,76% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,587.02,32.96,,,percent of total billed charges,32.96% of total billed charges,365.8,105,,,Fee Schedule,pays based on EAPG rates,1602.9,90,,,percent of total billed charges,90% of total billed charges,1602.9,90,,,percent of total billed charges,90% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1577.97,88.6,,,percent of total billed charges,88.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,569.92,32,,,percent of total billed charges,32% of total billed charges,1424.8,80,,,percent of total billed charges,80% of total billed charges,1424.8,80,,,percent of total billed charges,80% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1620.71,91,,,percent of total billed charges,91% of total billed charges,581.32,32.64,,,percent of total billed charges,32.64% of total billed charges,569.92,32,,,percent of total billed charges,32% of total billed charges,598.42,33.6,,,percent of total billed charges,33.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,569.92,32,,,percent of total billed charges,32% of total billed charges,569.92,32,,,percent of total billed charges,32% of total billed charges,1638.52,92,,,percent of total billed charges,92% of total billed charges,348.38,1638.52,
SPINAL PUNCTURE THERAPEUTIC,4000122,CDM,320,RC,62272,HCPCS,Outpatient,,,1781,1513.85,,1446.17,81.2,,,percent of total billed charges,81.2% of total billed charges,581.32,32.64,,,percent of total billed charges,32.64% of total billed charges,1317.94,74,,,percent of total billed charges,74% of total billed charges,1317.94,74,,,percent of total billed charges,74% of total billed charges,569.92,32,,,percent of total billed charges,32% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,569.92,32,,,percent of total billed charges,32% of total billed charges,1264.51,71,,,percent of total billed charges,71% of total billed charges,1264.51,71,,,percent of total billed charges,71% of total billed charges,1193.27,67,,,percent of total billed charges,67% of total billed charges,1193.27,67,,,percent of total billed charges,67% of total billed charges,1264.51,71,,,percent of total billed charges,71% of total billed charges,1353.56,76,,,percent of total billed charges,76% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,587.02,32.96,,,percent of total billed charges,32.96% of total billed charges,365.8,105,,,Fee Schedule,pays based on EAPG rates,1602.9,90,,,percent of total billed charges,90% of total billed charges,1602.9,90,,,percent of total billed charges,90% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1577.97,88.6,,,percent of total billed charges,88.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,569.92,32,,,percent of total billed charges,32% of total billed charges,1424.8,80,,,percent of total billed charges,80% of total billed charges,1424.8,80,,,percent of total billed charges,80% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,1620.71,91,,,percent of total billed charges,91% of total billed charges,581.32,32.64,,,percent of total billed charges,32.64% of total billed charges,569.92,32,,,percent of total billed charges,32% of total billed charges,598.42,33.6,,,percent of total billed charges,33.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,569.92,32,,,percent of total billed charges,32% of total billed charges,569.92,32,,,percent of total billed charges,32% of total billed charges,1638.52,92,,,percent of total billed charges,92% of total billed charges,348.38,1638.52,
INJ PROCEURE FOR CT MYELOGRAM,4000296,CDM,320,RC,62284,HCPCS,Outpatient,,,264,224.4,,214.37,81.2,,,percent of total billed charges,81.2% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,195.36,74,,,percent of total billed charges,74% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,176.88,67,,,percent of total billed charges,67% of total billed charges,187.44,71,,,percent of total billed charges,71% of total billed charges,200.64,76,,,percent of total billed charges,76% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,87.01,32.96,,,percent of total billed charges,32.96% of total billed charges,53.03,105,,,Fee Schedule,pays based on EAPG rates,237.6,90,,,percent of total billed charges,90% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,233.9,88.6,,,percent of total billed charges,88.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,211.2,80,,,percent of total billed charges,80% of total billed charges,50.51,100,,,Fee Schedule,pays based on EAPG rates,240.24,91,,,percent of total billed charges,91% of total billed charges,86.17,32.64,,,percent of total billed charges,32.64% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,88.7,33.6,,,percent of total billed charges,33.6% of total billed charges,52.02,103,,,Fee Schedule,pays based on EAPG rates,84.48,32,,,percent of total billed charges,32% of total billed charges,84.48,32,,,percent of total billed charges,32% of total billed charges,242.88,92,,,percent of total billed charges,92% of total billed charges,50.51,242.88,
SPINAL PUNCTURE LMBR DIAG W/ FLUORO,4000401,CDM,320,RC,62328,HCPCS,Outpatient,,,2772,2356.2,,2250.86,81.2,,,percent of total billed charges,81.2% of total billed charges,904.78,32.64,,,percent of total billed charges,32.64% of total billed charges,2051.28,74,,,percent of total billed charges,74% of total billed charges,2051.28,74,,,percent of total billed charges,74% of total billed charges,887.04,32,,,percent of total billed charges,32% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,887.04,32,,,percent of total billed charges,32% of total billed charges,1968.12,71,,,percent of total billed charges,71% of total billed charges,1968.12,71,,,percent of total billed charges,71% of total billed charges,1857.24,67,,,percent of total billed charges,67% of total billed charges,1857.24,67,,,percent of total billed charges,67% of total billed charges,1968.12,71,,,percent of total billed charges,71% of total billed charges,2106.72,76,,,percent of total billed charges,76% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,913.65,32.96,,,percent of total billed charges,32.96% of total billed charges,365.8,105,,,Fee Schedule,pays based on EAPG rates,2494.8,90,,,percent of total billed charges,90% of total billed charges,2494.8,90,,,percent of total billed charges,90% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,2455.99,88.6,,,percent of total billed charges,88.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,887.04,32,,,percent of total billed charges,32% of total billed charges,2217.6,80,,,percent of total billed charges,80% of total billed charges,2217.6,80,,,percent of total billed charges,80% of total billed charges,348.38,100,,,Fee Schedule,pays based on EAPG rates,2522.52,91,,,percent of total billed charges,91% of total billed charges,904.78,32.64,,,percent of total billed charges,32.64% of total billed charges,887.04,32,,,percent of total billed charges,32% of total billed charges,931.39,33.6,,,percent of total billed charges,33.6% of total billed charges,358.84,103,,,Fee Schedule,pays based on EAPG rates,887.04,32,,,percent of total billed charges,32% of total billed charges,887.04,32,,,percent of total billed charges,32% of total billed charges,2550.24,92,,,percent of total billed charges,92% of total billed charges,348.38,2550.24,
ORBIT FOREIGN BODY,4000386,CDM,320,RC,70030,HCPCS,Outpatient,,,281,238.85,,228.17,81.2,,,percent of total billed charges,81.2% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,207.94,74,,,percent of total billed charges,74% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,188.27,67,,,percent of total billed charges,67% of total billed charges,199.51,71,,,percent of total billed charges,71% of total billed charges,213.56,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,92.62,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,252.9,90,,,percent of total billed charges,90% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,248.97,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,224.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,255.71,91,,,percent of total billed charges,91% of total billed charges,91.72,32.64,,,percent of total billed charges,32.64% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,94.42,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,89.92,32,,,percent of total billed charges,32% of total billed charges,89.92,32,,,percent of total billed charges,32% of total billed charges,258.52,92,,,percent of total billed charges,92% of total billed charges,34.98,258.52,
MANDIBLE <4V,4000161,CDM,320,RC,70100,HCPCS,Outpatient,,,245,208.25,,198.94,81.2,,,percent of total billed charges,81.2% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,186.2,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,80.75,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,220.5,90,,,percent of total billed charges,90% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,217.07,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,222.95,91,,,percent of total billed charges,91% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,82.32,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,225.4,92,,,percent of total billed charges,92% of total billed charges,34.98,225.4,
MASTOIDS MIN 3V,4000222,CDM,320,RC,70130,HCPCS,Outpatient,,,278,236.3,,225.74,81.2,,,percent of total billed charges,81.2% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,211.28,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.63,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,250.2,90,,,percent of total billed charges,90% of total billed charges,250.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,246.31,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.98,91,,,percent of total billed charges,91% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,93.41,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,255.76,92,,,percent of total billed charges,92% of total billed charges,34.98,255.76,
FACIAL BONES < 3V,4000221,CDM,320,RC,70140,HCPCS,Outpatient,,,267,226.95,,216.8,81.2,,,percent of total billed charges,81.2% of total billed charges,87.15,32.64,,,percent of total billed charges,32.64% of total billed charges,197.58,74,,,percent of total billed charges,74% of total billed charges,197.58,74,,,percent of total billed charges,74% of total billed charges,85.44,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,85.44,32,,,percent of total billed charges,32% of total billed charges,189.57,71,,,percent of total billed charges,71% of total billed charges,189.57,71,,,percent of total billed charges,71% of total billed charges,178.89,67,,,percent of total billed charges,67% of total billed charges,178.89,67,,,percent of total billed charges,67% of total billed charges,189.57,71,,,percent of total billed charges,71% of total billed charges,202.92,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,240.3,90,,,percent of total billed charges,90% of total billed charges,240.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,236.56,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,85.44,32,,,percent of total billed charges,32% of total billed charges,213.6,80,,,percent of total billed charges,80% of total billed charges,213.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,242.97,91,,,percent of total billed charges,91% of total billed charges,87.15,32.64,,,percent of total billed charges,32.64% of total billed charges,85.44,32,,,percent of total billed charges,32% of total billed charges,89.71,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,85.44,32,,,percent of total billed charges,32% of total billed charges,85.44,32,,,percent of total billed charges,32% of total billed charges,245.64,92,,,percent of total billed charges,92% of total billed charges,34.98,245.64,
FACIAL BONES MIN 3V,4000076,CDM,320,RC,70150,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
NASAL BONES MIN 3V,4000080,CDM,320,RC,70160,HCPCS,Outpatient,,,185,157.25,,150.22,81.2,,,percent of total billed charges,81.2% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,136.9,74,,,percent of total billed charges,74% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,123.95,67,,,percent of total billed charges,67% of total billed charges,131.35,71,,,percent of total billed charges,71% of total billed charges,140.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,60.98,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,163.91,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,148,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,168.35,91,,,percent of total billed charges,91% of total billed charges,60.38,32.64,,,percent of total billed charges,32.64% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,62.16,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,59.2,32,,,percent of total billed charges,32% of total billed charges,59.2,32,,,percent of total billed charges,32% of total billed charges,170.2,92,,,percent of total billed charges,92% of total billed charges,34.98,170.2,
ORBIT < 4V LT - OPTIC FORAMINA,4000223,CDM,320,RC,70190,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,34.98,197.8,
ORBIT < 4V RT - OPTIC FORAMINA,4000224,CDM,320,RC,70190,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,34.98,197.8,
ORBIT < 4V BILAT - OPTIC FORAMINA,4000262,CDM,320,RC,70190,HCPCS,Outpatient,,,402,341.7,,326.42,81.2,,,percent of total billed charges,81.2% of total billed charges,131.21,32.64,,,percent of total billed charges,32.64% of total billed charges,297.48,74,,,percent of total billed charges,74% of total billed charges,297.48,74,,,percent of total billed charges,74% of total billed charges,128.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.64,32,,,percent of total billed charges,32% of total billed charges,285.42,71,,,percent of total billed charges,71% of total billed charges,285.42,71,,,percent of total billed charges,71% of total billed charges,269.34,67,,,percent of total billed charges,67% of total billed charges,269.34,67,,,percent of total billed charges,67% of total billed charges,285.42,71,,,percent of total billed charges,71% of total billed charges,305.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,132.5,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,361.8,90,,,percent of total billed charges,90% of total billed charges,361.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,356.17,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.64,32,,,percent of total billed charges,32% of total billed charges,321.6,80,,,percent of total billed charges,80% of total billed charges,321.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,365.82,91,,,percent of total billed charges,91% of total billed charges,131.21,32.64,,,percent of total billed charges,32.64% of total billed charges,128.64,32,,,percent of total billed charges,32% of total billed charges,135.07,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.64,32,,,percent of total billed charges,32% of total billed charges,128.64,32,,,percent of total billed charges,32% of total billed charges,369.84,92,,,percent of total billed charges,92% of total billed charges,34.98,369.84,
ORBIT MIN 4V LT,4000162,CDM,320,RC,70200,HCPCS,Outpatient,,,246,209.1,,199.75,81.2,,,percent of total billed charges,81.2% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,186.96,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.08,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,217.96,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,223.86,91,,,percent of total billed charges,91% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,82.66,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,226.32,92,,,percent of total billed charges,92% of total billed charges,34.98,226.32,
ORBIT MIN 4V RT,4000190,CDM,320,RC,70200,HCPCS,Outpatient,,,246,209.1,,199.75,81.2,,,percent of total billed charges,81.2% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,186.96,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.08,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,217.96,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,223.86,91,,,percent of total billed charges,91% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,82.66,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,226.32,92,,,percent of total billed charges,92% of total billed charges,34.98,226.32,
ORBIT MIN 4V BILAT,4000119,CDM,320,RC,70200,HCPCS,Outpatient,,,394,334.9,,319.93,81.2,,,percent of total billed charges,81.2% of total billed charges,128.6,32.64,,,percent of total billed charges,32.64% of total billed charges,291.56,74,,,percent of total billed charges,74% of total billed charges,291.56,74,,,percent of total billed charges,74% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,263.98,67,,,percent of total billed charges,67% of total billed charges,263.98,67,,,percent of total billed charges,67% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,299.44,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,129.86,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,354.6,90,,,percent of total billed charges,90% of total billed charges,354.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,349.08,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,315.2,80,,,percent of total billed charges,80% of total billed charges,315.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,358.54,91,,,percent of total billed charges,91% of total billed charges,128.6,32.64,,,percent of total billed charges,32.64% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,132.38,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,362.48,92,,,percent of total billed charges,92% of total billed charges,34.98,362.48,
SINUS <3V,4000399,CDM,320,RC,70210,HCPCS,Outpatient,,,276,234.6,,224.11,81.2,,,percent of total billed charges,81.2% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,209.76,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,90.97,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,248.4,90,,,percent of total billed charges,90% of total billed charges,248.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,244.54,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,251.16,91,,,percent of total billed charges,91% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,92.74,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,253.92,92,,,percent of total billed charges,92% of total billed charges,34.98,253.92,
SINUS MIN 3V,4000082,CDM,320,RC,70220,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
SKULL < 4V,4000084,CDM,320,RC,70250,HCPCS,Outpatient,,,210,178.5,,170.52,81.2,,,percent of total billed charges,81.2% of total billed charges,68.54,32.64,,,percent of total billed charges,32.64% of total billed charges,155.4,74,,,percent of total billed charges,74% of total billed charges,155.4,74,,,percent of total billed charges,74% of total billed charges,67.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,67.2,32,,,percent of total billed charges,32% of total billed charges,149.1,71,,,percent of total billed charges,71% of total billed charges,149.1,71,,,percent of total billed charges,71% of total billed charges,140.7,67,,,percent of total billed charges,67% of total billed charges,140.7,67,,,percent of total billed charges,67% of total billed charges,149.1,71,,,percent of total billed charges,71% of total billed charges,159.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,69.22,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,186.06,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,67.2,32,,,percent of total billed charges,32% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,191.1,91,,,percent of total billed charges,91% of total billed charges,68.54,32.64,,,percent of total billed charges,32.64% of total billed charges,67.2,32,,,percent of total billed charges,32% of total billed charges,70.56,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,67.2,32,,,percent of total billed charges,32% of total billed charges,67.2,32,,,percent of total billed charges,32% of total billed charges,193.2,92,,,percent of total billed charges,92% of total billed charges,34.98,193.2,
SKULL MIN 4V,4000083,CDM,320,RC,70260,HCPCS,Outpatient,,,298,253.3,,241.98,81.2,,,percent of total billed charges,81.2% of total billed charges,97.27,32.64,,,percent of total billed charges,32.64% of total billed charges,220.52,74,,,percent of total billed charges,74% of total billed charges,220.52,74,,,percent of total billed charges,74% of total billed charges,95.36,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.36,32,,,percent of total billed charges,32% of total billed charges,211.58,71,,,percent of total billed charges,71% of total billed charges,211.58,71,,,percent of total billed charges,71% of total billed charges,199.66,67,,,percent of total billed charges,67% of total billed charges,199.66,67,,,percent of total billed charges,67% of total billed charges,211.58,71,,,percent of total billed charges,71% of total billed charges,226.48,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.22,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,264.03,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.36,32,,,percent of total billed charges,32% of total billed charges,238.4,80,,,percent of total billed charges,80% of total billed charges,238.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,271.18,91,,,percent of total billed charges,91% of total billed charges,97.27,32.64,,,percent of total billed charges,32.64% of total billed charges,95.36,32,,,percent of total billed charges,32% of total billed charges,100.13,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.36,32,,,percent of total billed charges,32% of total billed charges,95.36,32,,,percent of total billed charges,32% of total billed charges,274.16,92,,,percent of total billed charges,92% of total billed charges,34.98,274.16,
TMJ LT,4000166,CDM,320,RC,70328,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,34.98,284.28,
TMJ RT,4000193,CDM,320,RC,70328,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,34.98,284.28,
TMJ BILAT,4000211,CDM,320,RC,70330,HCPCS,Outpatient,,,613,521.05,,497.76,81.2,,,percent of total billed charges,81.2% of total billed charges,200.08,32.64,,,percent of total billed charges,32.64% of total billed charges,453.62,74,,,percent of total billed charges,74% of total billed charges,453.62,74,,,percent of total billed charges,74% of total billed charges,196.16,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,196.16,32,,,percent of total billed charges,32% of total billed charges,435.23,71,,,percent of total billed charges,71% of total billed charges,435.23,71,,,percent of total billed charges,71% of total billed charges,410.71,67,,,percent of total billed charges,67% of total billed charges,410.71,67,,,percent of total billed charges,67% of total billed charges,435.23,71,,,percent of total billed charges,71% of total billed charges,465.88,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,202.04,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,551.7,90,,,percent of total billed charges,90% of total billed charges,551.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,543.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,196.16,32,,,percent of total billed charges,32% of total billed charges,490.4,80,,,percent of total billed charges,80% of total billed charges,490.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,557.83,91,,,percent of total billed charges,91% of total billed charges,200.08,32.64,,,percent of total billed charges,32.64% of total billed charges,196.16,32,,,percent of total billed charges,32% of total billed charges,205.97,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,196.16,32,,,percent of total billed charges,32% of total billed charges,196.16,32,,,percent of total billed charges,32% of total billed charges,563.96,92,,,percent of total billed charges,92% of total billed charges,34.98,563.96,
NECK ST 2V,4000100,CDM,320,RC,70360,HCPCS,Outpatient,,,233,198.05,,189.2,81.2,,,percent of total billed charges,81.2% of total billed charges,76.05,32.64,,,percent of total billed charges,32.64% of total billed charges,172.42,74,,,percent of total billed charges,74% of total billed charges,172.42,74,,,percent of total billed charges,74% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,156.11,67,,,percent of total billed charges,67% of total billed charges,156.11,67,,,percent of total billed charges,67% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,177.08,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,76.8,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,209.7,90,,,percent of total billed charges,90% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.44,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,212.03,91,,,percent of total billed charges,91% of total billed charges,76.05,32.64,,,percent of total billed charges,32.64% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,78.29,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,214.36,92,,,percent of total billed charges,92% of total billed charges,34.98,214.36,
CHEST 1V,4000067,CDM,320,RC,71045,HCPCS,Outpatient,,,227,192.95,,184.32,81.2,,,percent of total billed charges,81.2% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,172.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.82,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,201.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.57,91,,,percent of total billed charges,91% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,76.27,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,208.84,92,,,percent of total billed charges,92% of total billed charges,34.98,208.84,
CHEST PORTABLE 1V,4000290,CDM,324,RC,71045,HCPCS,Outpatient,,,227,192.95,,184.32,81.2,,,percent of total billed charges,81.2% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,172.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.82,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,201.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.57,91,,,percent of total billed charges,91% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,76.27,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,208.84,92,,,percent of total billed charges,92% of total billed charges,34.98,208.84,
CHEST 2V,4000068,CDM,320,RC,71046,HCPCS,Outpatient,,,243,206.55,,197.32,81.2,,,percent of total billed charges,81.2% of total billed charges,79.32,32.64,,,percent of total billed charges,32.64% of total billed charges,179.82,74,,,percent of total billed charges,74% of total billed charges,179.82,74,,,percent of total billed charges,74% of total billed charges,77.76,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,77.76,32,,,percent of total billed charges,32% of total billed charges,172.53,71,,,percent of total billed charges,71% of total billed charges,172.53,71,,,percent of total billed charges,71% of total billed charges,162.81,67,,,percent of total billed charges,67% of total billed charges,162.81,67,,,percent of total billed charges,67% of total billed charges,172.53,71,,,percent of total billed charges,71% of total billed charges,184.68,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,80.09,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,218.7,90,,,percent of total billed charges,90% of total billed charges,218.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,215.3,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,77.76,32,,,percent of total billed charges,32% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,221.13,91,,,percent of total billed charges,91% of total billed charges,79.32,32.64,,,percent of total billed charges,32.64% of total billed charges,77.76,32,,,percent of total billed charges,32% of total billed charges,81.65,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,77.76,32,,,percent of total billed charges,32% of total billed charges,77.76,32,,,percent of total billed charges,32% of total billed charges,223.56,92,,,percent of total billed charges,92% of total billed charges,34.98,223.56,
CHEST 3V,4000270,CDM,320,RC,71047,HCPCS,Outpatient,,,257,218.45,,208.68,81.2,,,percent of total billed charges,81.2% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,195.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.71,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,227.7,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,233.87,91,,,percent of total billed charges,91% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,86.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,236.44,92,,,percent of total billed charges,92% of total billed charges,34.98,236.44,
CHEST 4V OR MORE,4000070,CDM,320,RC,71048,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
RIBS 2V LT,4000164,CDM,320,RC,71100,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
RIBS 2V RT,4000192,CDM,320,RC,71100,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
RIBS W/PA CXR MIN 3V LT,4000226,CDM,320,RC,71101,HCPCS,Outpatient,,,355,301.75,,288.26,81.2,,,percent of total billed charges,81.2% of total billed charges,115.87,32.64,,,percent of total billed charges,32.64% of total billed charges,262.7,74,,,percent of total billed charges,74% of total billed charges,262.7,74,,,percent of total billed charges,74% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,237.85,67,,,percent of total billed charges,67% of total billed charges,237.85,67,,,percent of total billed charges,67% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,269.8,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,117.01,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,319.5,90,,,percent of total billed charges,90% of total billed charges,319.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,314.53,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,284,80,,,percent of total billed charges,80% of total billed charges,284,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,323.05,91,,,percent of total billed charges,91% of total billed charges,115.87,32.64,,,percent of total billed charges,32.64% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,119.28,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,326.6,92,,,percent of total billed charges,92% of total billed charges,34.98,326.6,
RIBS W/PA CXR MIN 3V RT,4000227,CDM,320,RC,71101,HCPCS,Outpatient,,,355,301.75,,288.26,81.2,,,percent of total billed charges,81.2% of total billed charges,115.87,32.64,,,percent of total billed charges,32.64% of total billed charges,262.7,74,,,percent of total billed charges,74% of total billed charges,262.7,74,,,percent of total billed charges,74% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,237.85,67,,,percent of total billed charges,67% of total billed charges,237.85,67,,,percent of total billed charges,67% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,269.8,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,117.01,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,319.5,90,,,percent of total billed charges,90% of total billed charges,319.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,314.53,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,284,80,,,percent of total billed charges,80% of total billed charges,284,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,323.05,91,,,percent of total billed charges,91% of total billed charges,115.87,32.64,,,percent of total billed charges,32.64% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,119.28,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,326.6,92,,,percent of total billed charges,92% of total billed charges,34.98,326.6,
RIBS 3V BILAT,4000165,CDM,320,RC,71110,HCPCS,Outpatient,,,334,283.9,,271.21,81.2,,,percent of total billed charges,81.2% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,253.84,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,110.09,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,295.92,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,303.94,91,,,percent of total billed charges,91% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,112.22,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,307.28,92,,,percent of total billed charges,92% of total billed charges,34.98,307.28,
RIBS W/ PA CXR MIN 4V BILAT,4000225,CDM,320,RC,71111,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
STERNUM MIN 2V,4000085,CDM,320,RC,71120,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
EXT SC JOINTS MIN 3 VIEWS,4000357,CDM,320,RC,71130,HCPCS,Outpatient,,,276,234.6,,224.11,81.2,,,percent of total billed charges,81.2% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,209.76,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,90.97,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,248.4,90,,,percent of total billed charges,90% of total billed charges,248.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,244.54,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,251.16,91,,,percent of total billed charges,91% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,92.74,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,253.92,92,,,percent of total billed charges,92% of total billed charges,34.98,253.92,
CERVICAL SPINE 1V,4000111,CDM,320,RC,72020,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,34.98,284.28,
LUMBAR SPINE 1V,4000233,CDM,320,RC,72020,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,34.98,284.28,
CERVICAL SPINE 2-3V,4000212,CDM,320,RC,72040,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
CERVICAL SPINE 4 OR 5 VIEW,4000319,CDM,320,RC,72050,HCPCS,Outpatient,,,543,461.55,,440.92,81.2,,,percent of total billed charges,81.2% of total billed charges,177.24,32.64,,,percent of total billed charges,32.64% of total billed charges,401.82,74,,,percent of total billed charges,74% of total billed charges,401.82,74,,,percent of total billed charges,74% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,363.81,67,,,percent of total billed charges,67% of total billed charges,363.81,67,,,percent of total billed charges,67% of total billed charges,385.53,71,,,percent of total billed charges,71% of total billed charges,412.68,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,178.97,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,488.7,90,,,percent of total billed charges,90% of total billed charges,488.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,481.1,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,434.4,80,,,percent of total billed charges,80% of total billed charges,434.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,494.13,91,,,percent of total billed charges,91% of total billed charges,177.24,32.64,,,percent of total billed charges,32.64% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,182.45,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,173.76,32,,,percent of total billed charges,32% of total billed charges,173.76,32,,,percent of total billed charges,32% of total billed charges,499.56,92,,,percent of total billed charges,92% of total billed charges,34.98,499.56,
CERVICAL SPINE 6V OR >,4000072,CDM,320,RC,72052,HCPCS,Outpatient,,,582,494.7,,472.58,81.2,,,percent of total billed charges,81.2% of total billed charges,189.96,32.64,,,percent of total billed charges,32.64% of total billed charges,430.68,74,,,percent of total billed charges,74% of total billed charges,430.68,74,,,percent of total billed charges,74% of total billed charges,186.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,186.24,32,,,percent of total billed charges,32% of total billed charges,413.22,71,,,percent of total billed charges,71% of total billed charges,413.22,71,,,percent of total billed charges,71% of total billed charges,389.94,67,,,percent of total billed charges,67% of total billed charges,389.94,67,,,percent of total billed charges,67% of total billed charges,413.22,71,,,percent of total billed charges,71% of total billed charges,442.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,191.83,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,523.8,90,,,percent of total billed charges,90% of total billed charges,523.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,515.65,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,186.24,32,,,percent of total billed charges,32% of total billed charges,465.6,80,,,percent of total billed charges,80% of total billed charges,465.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,529.62,91,,,percent of total billed charges,91% of total billed charges,189.96,32.64,,,percent of total billed charges,32.64% of total billed charges,186.24,32,,,percent of total billed charges,32% of total billed charges,195.55,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,186.24,32,,,percent of total billed charges,32% of total billed charges,186.24,32,,,percent of total billed charges,32% of total billed charges,535.44,92,,,percent of total billed charges,92% of total billed charges,34.98,535.44,
THORACIC SPINE  2v,4000074,CDM,320,RC,72070,HCPCS,Outpatient,,,233,198.05,,189.2,81.2,,,percent of total billed charges,81.2% of total billed charges,76.05,32.64,,,percent of total billed charges,32.64% of total billed charges,172.42,74,,,percent of total billed charges,74% of total billed charges,172.42,74,,,percent of total billed charges,74% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,156.11,67,,,percent of total billed charges,67% of total billed charges,156.11,67,,,percent of total billed charges,67% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,177.08,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,76.8,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,209.7,90,,,percent of total billed charges,90% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.44,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,212.03,91,,,percent of total billed charges,91% of total billed charges,76.05,32.64,,,percent of total billed charges,32.64% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,78.29,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,214.36,92,,,percent of total billed charges,92% of total billed charges,34.98,214.36,
THORACIC SPINE MIN 4V,4000075,CDM,320,RC,72074,HCPCS,Outpatient,,,292,248.2,,237.1,81.2,,,percent of total billed charges,81.2% of total billed charges,95.31,32.64,,,percent of total billed charges,32.64% of total billed charges,216.08,74,,,percent of total billed charges,74% of total billed charges,216.08,74,,,percent of total billed charges,74% of total billed charges,93.44,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.44,32,,,percent of total billed charges,32% of total billed charges,207.32,71,,,percent of total billed charges,71% of total billed charges,207.32,71,,,percent of total billed charges,71% of total billed charges,195.64,67,,,percent of total billed charges,67% of total billed charges,195.64,67,,,percent of total billed charges,67% of total billed charges,207.32,71,,,percent of total billed charges,71% of total billed charges,221.92,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,96.24,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,262.8,90,,,percent of total billed charges,90% of total billed charges,262.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,258.71,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.44,32,,,percent of total billed charges,32% of total billed charges,233.6,80,,,percent of total billed charges,80% of total billed charges,233.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,265.72,91,,,percent of total billed charges,91% of total billed charges,95.31,32.64,,,percent of total billed charges,32.64% of total billed charges,93.44,32,,,percent of total billed charges,32% of total billed charges,98.11,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.44,32,,,percent of total billed charges,32% of total billed charges,93.44,32,,,percent of total billed charges,32% of total billed charges,268.64,92,,,percent of total billed charges,92% of total billed charges,34.98,268.64,
SCOLIOSIS SERIES 1V,4000104,CDM,320,RC,72081,HCPCS,Outpatient,,,420,357,,341.04,81.2,,,percent of total billed charges,81.2% of total billed charges,137.09,32.64,,,percent of total billed charges,32.64% of total billed charges,310.8,74,,,percent of total billed charges,74% of total billed charges,310.8,74,,,percent of total billed charges,74% of total billed charges,134.4,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,134.4,32,,,percent of total billed charges,32% of total billed charges,298.2,71,,,percent of total billed charges,71% of total billed charges,298.2,71,,,percent of total billed charges,71% of total billed charges,281.4,67,,,percent of total billed charges,67% of total billed charges,281.4,67,,,percent of total billed charges,67% of total billed charges,298.2,71,,,percent of total billed charges,71% of total billed charges,319.2,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,138.43,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,378,90,,,percent of total billed charges,90% of total billed charges,378,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,372.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,134.4,32,,,percent of total billed charges,32% of total billed charges,336,80,,,percent of total billed charges,80% of total billed charges,336,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,382.2,91,,,percent of total billed charges,91% of total billed charges,137.09,32.64,,,percent of total billed charges,32.64% of total billed charges,134.4,32,,,percent of total billed charges,32% of total billed charges,141.12,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,134.4,32,,,percent of total billed charges,32% of total billed charges,134.4,32,,,percent of total billed charges,32% of total billed charges,386.4,92,,,percent of total billed charges,92% of total billed charges,34.98,386.4,
SCOLIOSIS SERIES 2-3V,4000387,CDM,320,RC,72082,HCPCS,Outpatient,,,507,430.95,,411.68,81.2,,,percent of total billed charges,81.2% of total billed charges,165.48,32.64,,,percent of total billed charges,32.64% of total billed charges,375.18,74,,,percent of total billed charges,74% of total billed charges,375.18,74,,,percent of total billed charges,74% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,162.24,32,,,percent of total billed charges,32% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,339.69,67,,,percent of total billed charges,67% of total billed charges,339.69,67,,,percent of total billed charges,67% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,385.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,167.11,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,456.3,90,,,percent of total billed charges,90% of total billed charges,456.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,449.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,162.24,32,,,percent of total billed charges,32% of total billed charges,405.6,80,,,percent of total billed charges,80% of total billed charges,405.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,461.37,91,,,percent of total billed charges,91% of total billed charges,165.48,32.64,,,percent of total billed charges,32.64% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,170.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,162.24,32,,,percent of total billed charges,32% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,466.44,92,,,percent of total billed charges,92% of total billed charges,34.98,466.44,
LUMBAR SPINE 2 OR 3V,4000077,CDM,320,RC,72100,HCPCS,Outpatient,,,401,340.85,,325.61,81.2,,,percent of total billed charges,81.2% of total billed charges,130.89,32.64,,,percent of total billed charges,32.64% of total billed charges,296.74,74,,,percent of total billed charges,74% of total billed charges,296.74,74,,,percent of total billed charges,74% of total billed charges,128.32,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.32,32,,,percent of total billed charges,32% of total billed charges,284.71,71,,,percent of total billed charges,71% of total billed charges,284.71,71,,,percent of total billed charges,71% of total billed charges,268.67,67,,,percent of total billed charges,67% of total billed charges,268.67,67,,,percent of total billed charges,67% of total billed charges,284.71,71,,,percent of total billed charges,71% of total billed charges,304.76,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,132.17,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,360.9,90,,,percent of total billed charges,90% of total billed charges,360.9,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,355.29,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.32,32,,,percent of total billed charges,32% of total billed charges,320.8,80,,,percent of total billed charges,80% of total billed charges,320.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,364.91,91,,,percent of total billed charges,91% of total billed charges,130.89,32.64,,,percent of total billed charges,32.64% of total billed charges,128.32,32,,,percent of total billed charges,32% of total billed charges,134.74,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.32,32,,,percent of total billed charges,32% of total billed charges,128.32,32,,,percent of total billed charges,32% of total billed charges,368.92,92,,,percent of total billed charges,92% of total billed charges,34.98,368.92,
LUMBAR SPINE MIN 4V,4000078,CDM,320,RC,72110,HCPCS,Outpatient,,,447,379.95,,362.96,81.2,,,percent of total billed charges,81.2% of total billed charges,145.9,32.64,,,percent of total billed charges,32.64% of total billed charges,330.78,74,,,percent of total billed charges,74% of total billed charges,330.78,74,,,percent of total billed charges,74% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,299.49,67,,,percent of total billed charges,67% of total billed charges,299.49,67,,,percent of total billed charges,67% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,339.72,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,147.33,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,402.3,90,,,percent of total billed charges,90% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,396.04,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,406.77,91,,,percent of total billed charges,91% of total billed charges,145.9,32.64,,,percent of total billed charges,32.64% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,150.19,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,411.24,92,,,percent of total billed charges,92% of total billed charges,34.98,411.24,
PELVIS AP 1 OR 2V,4000081,CDM,320,RC,72170,HCPCS,Outpatient,,,210,178.5,,170.52,81.2,,,percent of total billed charges,81.2% of total billed charges,68.54,32.64,,,percent of total billed charges,32.64% of total billed charges,155.4,74,,,percent of total billed charges,74% of total billed charges,155.4,74,,,percent of total billed charges,74% of total billed charges,67.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,67.2,32,,,percent of total billed charges,32% of total billed charges,149.1,71,,,percent of total billed charges,71% of total billed charges,149.1,71,,,percent of total billed charges,71% of total billed charges,140.7,67,,,percent of total billed charges,67% of total billed charges,140.7,67,,,percent of total billed charges,67% of total billed charges,149.1,71,,,percent of total billed charges,71% of total billed charges,159.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,69.22,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,186.06,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,67.2,32,,,percent of total billed charges,32% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,168,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,191.1,91,,,percent of total billed charges,91% of total billed charges,68.54,32.64,,,percent of total billed charges,32.64% of total billed charges,67.2,32,,,percent of total billed charges,32% of total billed charges,70.56,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,67.2,32,,,percent of total billed charges,32% of total billed charges,67.2,32,,,percent of total billed charges,32% of total billed charges,193.2,92,,,percent of total billed charges,92% of total billed charges,34.98,193.2,
PELVIS COMPLETE MIN 3V,4000299,CDM,320,RC,72190,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
SI JTS MIN 3V,4000116,CDM,320,RC,72202,HCPCS,Outpatient,,,305,259.25,,247.66,81.2,,,percent of total billed charges,81.2% of total billed charges,99.55,32.64,,,percent of total billed charges,32.64% of total billed charges,225.7,74,,,percent of total billed charges,74% of total billed charges,225.7,74,,,percent of total billed charges,74% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,204.35,67,,,percent of total billed charges,67% of total billed charges,204.35,67,,,percent of total billed charges,67% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,231.8,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.53,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,274.5,90,,,percent of total billed charges,90% of total billed charges,274.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,270.23,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,277.55,91,,,percent of total billed charges,91% of total billed charges,99.55,32.64,,,percent of total billed charges,32.64% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,102.48,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,280.6,92,,,percent of total billed charges,92% of total billed charges,34.98,280.6,
SAC/COCCYX MIN 2V,4000073,CDM,320,RC,72220,HCPCS,Outpatient,,,389,330.65,,315.87,81.2,,,percent of total billed charges,81.2% of total billed charges,126.97,32.64,,,percent of total billed charges,32.64% of total billed charges,287.86,74,,,percent of total billed charges,74% of total billed charges,287.86,74,,,percent of total billed charges,74% of total billed charges,124.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,124.48,32,,,percent of total billed charges,32% of total billed charges,276.19,71,,,percent of total billed charges,71% of total billed charges,276.19,71,,,percent of total billed charges,71% of total billed charges,260.63,67,,,percent of total billed charges,67% of total billed charges,260.63,67,,,percent of total billed charges,67% of total billed charges,276.19,71,,,percent of total billed charges,71% of total billed charges,295.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.21,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,350.1,90,,,percent of total billed charges,90% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,344.65,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,124.48,32,,,percent of total billed charges,32% of total billed charges,311.2,80,,,percent of total billed charges,80% of total billed charges,311.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,353.99,91,,,percent of total billed charges,91% of total billed charges,126.97,32.64,,,percent of total billed charges,32.64% of total billed charges,124.48,32,,,percent of total billed charges,32% of total billed charges,130.7,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,124.48,32,,,percent of total billed charges,32% of total billed charges,124.48,32,,,percent of total billed charges,32% of total billed charges,357.88,92,,,percent of total billed charges,92% of total billed charges,34.98,357.88,
EXT CLAVICLE LT,4000125,CDM,320,RC,73000,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,34.98,197.8,
EXT CLAVICLE RT,4000174,CDM,320,RC,73000,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,34.98,197.8,
EXT CLAVICLE BILAT,4000197,CDM,320,RC,73000,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
EXT SCAPULA LT,4000146,CDM,320,RC,73010,HCPCS,Outpatient,,,227,192.95,,184.32,81.2,,,percent of total billed charges,81.2% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,172.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.82,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,201.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.57,91,,,percent of total billed charges,91% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,76.27,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,208.84,92,,,percent of total billed charges,92% of total billed charges,34.98,208.84,
EXT SCAPULA RT,4000185,CDM,320,RC,73010,HCPCS,Outpatient,,,227,192.95,,184.32,81.2,,,percent of total billed charges,81.2% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,172.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.82,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,201.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.57,91,,,percent of total billed charges,91% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,76.27,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,208.84,92,,,percent of total billed charges,92% of total billed charges,34.98,208.84,
EXT SCAPULA BILAT,4000206,CDM,320,RC,73010,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
EXT SHOULDER 1V LT,4000147,CDM,320,RC,73020,HCPCS,Outpatient,,,227,192.95,,184.32,81.2,,,percent of total billed charges,81.2% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,172.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.82,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,201.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.57,91,,,percent of total billed charges,91% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,76.27,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,208.84,92,,,percent of total billed charges,92% of total billed charges,34.98,208.84,
EXT SHOULDER 1V RT,4000186,CDM,320,RC,73020,HCPCS,Outpatient,,,227,192.95,,184.32,81.2,,,percent of total billed charges,81.2% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,172.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.82,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,201.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.57,91,,,percent of total billed charges,91% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,76.27,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,208.84,92,,,percent of total billed charges,92% of total billed charges,34.98,208.84,
EXT SHOULDER 1V BIL,4000207,CDM,320,RC,73020,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
EXT SHOULDER 2V LT,4000148,CDM,320,RC,73030,HCPCS,Outpatient,,,256,217.6,,207.87,81.2,,,percent of total billed charges,81.2% of total billed charges,83.56,32.64,,,percent of total billed charges,32.64% of total billed charges,189.44,74,,,percent of total billed charges,74% of total billed charges,189.44,74,,,percent of total billed charges,74% of total billed charges,81.92,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.92,32,,,percent of total billed charges,32% of total billed charges,181.76,71,,,percent of total billed charges,71% of total billed charges,181.76,71,,,percent of total billed charges,71% of total billed charges,171.52,67,,,percent of total billed charges,67% of total billed charges,171.52,67,,,percent of total billed charges,67% of total billed charges,181.76,71,,,percent of total billed charges,71% of total billed charges,194.56,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.38,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,230.4,90,,,percent of total billed charges,90% of total billed charges,230.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,226.82,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.92,32,,,percent of total billed charges,32% of total billed charges,204.8,80,,,percent of total billed charges,80% of total billed charges,204.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,232.96,91,,,percent of total billed charges,91% of total billed charges,83.56,32.64,,,percent of total billed charges,32.64% of total billed charges,81.92,32,,,percent of total billed charges,32% of total billed charges,86.02,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.92,32,,,percent of total billed charges,32% of total billed charges,81.92,32,,,percent of total billed charges,32% of total billed charges,235.52,92,,,percent of total billed charges,92% of total billed charges,34.98,235.52,
EXT SHOULDER 2V RT,4000187,CDM,320,RC,73030,HCPCS,Outpatient,,,256,217.6,,207.87,81.2,,,percent of total billed charges,81.2% of total billed charges,83.56,32.64,,,percent of total billed charges,32.64% of total billed charges,189.44,74,,,percent of total billed charges,74% of total billed charges,189.44,74,,,percent of total billed charges,74% of total billed charges,81.92,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.92,32,,,percent of total billed charges,32% of total billed charges,181.76,71,,,percent of total billed charges,71% of total billed charges,181.76,71,,,percent of total billed charges,71% of total billed charges,171.52,67,,,percent of total billed charges,67% of total billed charges,171.52,67,,,percent of total billed charges,67% of total billed charges,181.76,71,,,percent of total billed charges,71% of total billed charges,194.56,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.38,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,230.4,90,,,percent of total billed charges,90% of total billed charges,230.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,226.82,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.92,32,,,percent of total billed charges,32% of total billed charges,204.8,80,,,percent of total billed charges,80% of total billed charges,204.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,232.96,91,,,percent of total billed charges,91% of total billed charges,83.56,32.64,,,percent of total billed charges,32.64% of total billed charges,81.92,32,,,percent of total billed charges,32% of total billed charges,86.02,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.92,32,,,percent of total billed charges,32% of total billed charges,81.92,32,,,percent of total billed charges,32% of total billed charges,235.52,92,,,percent of total billed charges,92% of total billed charges,34.98,235.52,
EXT SHOULDER 3V LT,4000149,CDM,320,RC,73030,HCPCS,Outpatient,,,290,246.5,,235.48,81.2,,,percent of total billed charges,81.2% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,220.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.58,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,261,90,,,percent of total billed charges,90% of total billed charges,261,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,256.94,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,263.9,91,,,percent of total billed charges,91% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,97.44,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,266.8,92,,,percent of total billed charges,92% of total billed charges,34.98,266.8,
EXT SHOULDER 3V RT,4000188,CDM,320,RC,73030,HCPCS,Outpatient,,,290,246.5,,235.48,81.2,,,percent of total billed charges,81.2% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,214.6,74,,,percent of total billed charges,74% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,194.3,67,,,percent of total billed charges,67% of total billed charges,205.9,71,,,percent of total billed charges,71% of total billed charges,220.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.58,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,261,90,,,percent of total billed charges,90% of total billed charges,261,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,256.94,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,232,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,263.9,91,,,percent of total billed charges,91% of total billed charges,94.66,32.64,,,percent of total billed charges,32.64% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,97.44,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,92.8,32,,,percent of total billed charges,32% of total billed charges,92.8,32,,,percent of total billed charges,32% of total billed charges,266.8,92,,,percent of total billed charges,92% of total billed charges,34.98,266.8,
EXT SHOULDER 2V BIL,4000208,CDM,320,RC,73030,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
EXT SHOULDER 4V OR > RT,4000266,CDM,320,RC,73030,HCPCS,Outpatient,,,327,277.95,,265.52,81.2,,,percent of total billed charges,81.2% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,248.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,107.78,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,289.72,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,297.57,91,,,percent of total billed charges,91% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,109.87,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,300.84,92,,,percent of total billed charges,92% of total billed charges,34.98,300.84,
EXT SHOULDER 4V OR MORE LT,4000267,CDM,320,RC,73030,HCPCS,Outpatient,,,327,277.95,,265.52,81.2,,,percent of total billed charges,81.2% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,248.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,107.78,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,289.72,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,297.57,91,,,percent of total billed charges,91% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,109.87,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,300.84,92,,,percent of total billed charges,92% of total billed charges,34.98,300.84,
EXT SHOULDER 3V BIL,4000209,CDM,320,RC,73030,HCPCS,Outpatient,,,438,372.3,,355.66,81.2,,,percent of total billed charges,81.2% of total billed charges,142.96,32.64,,,percent of total billed charges,32.64% of total billed charges,324.12,74,,,percent of total billed charges,74% of total billed charges,324.12,74,,,percent of total billed charges,74% of total billed charges,140.16,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,140.16,32,,,percent of total billed charges,32% of total billed charges,310.98,71,,,percent of total billed charges,71% of total billed charges,310.98,71,,,percent of total billed charges,71% of total billed charges,293.46,67,,,percent of total billed charges,67% of total billed charges,293.46,67,,,percent of total billed charges,67% of total billed charges,310.98,71,,,percent of total billed charges,71% of total billed charges,332.88,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,144.36,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,394.2,90,,,percent of total billed charges,90% of total billed charges,394.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,388.07,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,140.16,32,,,percent of total billed charges,32% of total billed charges,350.4,80,,,percent of total billed charges,80% of total billed charges,350.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,398.58,91,,,percent of total billed charges,91% of total billed charges,142.96,32.64,,,percent of total billed charges,32.64% of total billed charges,140.16,32,,,percent of total billed charges,32% of total billed charges,147.17,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,140.16,32,,,percent of total billed charges,32% of total billed charges,140.16,32,,,percent of total billed charges,32% of total billed charges,402.96,92,,,percent of total billed charges,92% of total billed charges,34.98,402.96,
EXT SHOULDER 4V OR MORE BILAT,4000332,CDM,320,RC,73030,HCPCS,Outpatient,,,493,419.05,,400.32,81.2,,,percent of total billed charges,81.2% of total billed charges,160.92,32.64,,,percent of total billed charges,32.64% of total billed charges,364.82,74,,,percent of total billed charges,74% of total billed charges,364.82,74,,,percent of total billed charges,74% of total billed charges,157.76,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,157.76,32,,,percent of total billed charges,32% of total billed charges,350.03,71,,,percent of total billed charges,71% of total billed charges,350.03,71,,,percent of total billed charges,71% of total billed charges,330.31,67,,,percent of total billed charges,67% of total billed charges,330.31,67,,,percent of total billed charges,67% of total billed charges,350.03,71,,,percent of total billed charges,71% of total billed charges,374.68,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,162.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,443.7,90,,,percent of total billed charges,90% of total billed charges,443.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,436.8,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,157.76,32,,,percent of total billed charges,32% of total billed charges,394.4,80,,,percent of total billed charges,80% of total billed charges,394.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,448.63,91,,,percent of total billed charges,91% of total billed charges,160.92,32.64,,,percent of total billed charges,32.64% of total billed charges,157.76,32,,,percent of total billed charges,32% of total billed charges,165.65,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,157.76,32,,,percent of total billed charges,32% of total billed charges,157.76,32,,,percent of total billed charges,32% of total billed charges,453.56,92,,,percent of total billed charges,92% of total billed charges,34.98,453.56,
EXT AC JTS BILAT,4000103,CDM,320,RC,73050,HCPCS,Outpatient,,,276,234.6,,224.11,81.2,,,percent of total billed charges,81.2% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,209.76,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,90.97,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,248.4,90,,,percent of total billed charges,90% of total billed charges,248.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,244.54,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,251.16,91,,,percent of total billed charges,91% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,92.74,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,253.92,92,,,percent of total billed charges,92% of total billed charges,34.98,253.92,
EXT HUMERUS MIN 2V LT,4000142,CDM,320,RC,73060,HCPCS,Outpatient,,,255,216.75,,207.06,81.2,,,percent of total billed charges,81.2% of total billed charges,83.23,32.64,,,percent of total billed charges,32.64% of total billed charges,188.7,74,,,percent of total billed charges,74% of total billed charges,188.7,74,,,percent of total billed charges,74% of total billed charges,81.6,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.6,32,,,percent of total billed charges,32% of total billed charges,181.05,71,,,percent of total billed charges,71% of total billed charges,181.05,71,,,percent of total billed charges,71% of total billed charges,170.85,67,,,percent of total billed charges,67% of total billed charges,170.85,67,,,percent of total billed charges,67% of total billed charges,181.05,71,,,percent of total billed charges,71% of total billed charges,193.8,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.05,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,229.5,90,,,percent of total billed charges,90% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,225.93,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.6,32,,,percent of total billed charges,32% of total billed charges,204,80,,,percent of total billed charges,80% of total billed charges,204,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,232.05,91,,,percent of total billed charges,91% of total billed charges,83.23,32.64,,,percent of total billed charges,32.64% of total billed charges,81.6,32,,,percent of total billed charges,32% of total billed charges,85.68,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.6,32,,,percent of total billed charges,32% of total billed charges,81.6,32,,,percent of total billed charges,32% of total billed charges,234.6,92,,,percent of total billed charges,92% of total billed charges,34.98,234.6,
EXT HUMERUS MIN 2V RT,4000181,CDM,320,RC,73060,HCPCS,Outpatient,,,255,216.75,,207.06,81.2,,,percent of total billed charges,81.2% of total billed charges,83.23,32.64,,,percent of total billed charges,32.64% of total billed charges,188.7,74,,,percent of total billed charges,74% of total billed charges,188.7,74,,,percent of total billed charges,74% of total billed charges,81.6,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.6,32,,,percent of total billed charges,32% of total billed charges,181.05,71,,,percent of total billed charges,71% of total billed charges,181.05,71,,,percent of total billed charges,71% of total billed charges,170.85,67,,,percent of total billed charges,67% of total billed charges,170.85,67,,,percent of total billed charges,67% of total billed charges,181.05,71,,,percent of total billed charges,71% of total billed charges,193.8,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.05,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,229.5,90,,,percent of total billed charges,90% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,225.93,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.6,32,,,percent of total billed charges,32% of total billed charges,204,80,,,percent of total billed charges,80% of total billed charges,204,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,232.05,91,,,percent of total billed charges,91% of total billed charges,83.23,32.64,,,percent of total billed charges,32.64% of total billed charges,81.6,32,,,percent of total billed charges,32% of total billed charges,85.68,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.6,32,,,percent of total billed charges,32% of total billed charges,81.6,32,,,percent of total billed charges,32% of total billed charges,234.6,92,,,percent of total billed charges,92% of total billed charges,34.98,234.6,
EXT HUMERUS MIN 2V BILAT,4000203,CDM,320,RC,73060,HCPCS,Outpatient,,,383,325.55,,311,81.2,,,percent of total billed charges,81.2% of total billed charges,125.01,32.64,,,percent of total billed charges,32.64% of total billed charges,283.42,74,,,percent of total billed charges,74% of total billed charges,283.42,74,,,percent of total billed charges,74% of total billed charges,122.56,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,122.56,32,,,percent of total billed charges,32% of total billed charges,271.93,71,,,percent of total billed charges,71% of total billed charges,271.93,71,,,percent of total billed charges,71% of total billed charges,256.61,67,,,percent of total billed charges,67% of total billed charges,256.61,67,,,percent of total billed charges,67% of total billed charges,271.93,71,,,percent of total billed charges,71% of total billed charges,291.08,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,126.24,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,344.7,90,,,percent of total billed charges,90% of total billed charges,344.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,339.34,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,122.56,32,,,percent of total billed charges,32% of total billed charges,306.4,80,,,percent of total billed charges,80% of total billed charges,306.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,348.53,91,,,percent of total billed charges,91% of total billed charges,125.01,32.64,,,percent of total billed charges,32.64% of total billed charges,122.56,32,,,percent of total billed charges,32% of total billed charges,128.69,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,122.56,32,,,percent of total billed charges,32% of total billed charges,122.56,32,,,percent of total billed charges,32% of total billed charges,352.36,92,,,percent of total billed charges,92% of total billed charges,34.98,352.36,
EXT ELBOW 2V LT,4000126,CDM,320,RC,73070,HCPCS,Outpatient,,,165,140.25,,133.98,81.2,,,percent of total billed charges,81.2% of total billed charges,53.86,32.64,,,percent of total billed charges,32.64% of total billed charges,122.1,74,,,percent of total billed charges,74% of total billed charges,122.1,74,,,percent of total billed charges,74% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,52.8,32,,,percent of total billed charges,32% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,110.55,67,,,percent of total billed charges,67% of total billed charges,110.55,67,,,percent of total billed charges,67% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,125.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,54.38,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,148.5,90,,,percent of total billed charges,90% of total billed charges,148.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,146.19,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,52.8,32,,,percent of total billed charges,32% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,150.15,91,,,percent of total billed charges,91% of total billed charges,53.86,32.64,,,percent of total billed charges,32.64% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,55.44,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,52.8,32,,,percent of total billed charges,32% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,151.8,92,,,percent of total billed charges,92% of total billed charges,34.98,151.8,
EXT ELBOW 2V RT,4000175,CDM,320,RC,73070,HCPCS,Outpatient,,,165,140.25,,133.98,81.2,,,percent of total billed charges,81.2% of total billed charges,53.86,32.64,,,percent of total billed charges,32.64% of total billed charges,122.1,74,,,percent of total billed charges,74% of total billed charges,122.1,74,,,percent of total billed charges,74% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,52.8,32,,,percent of total billed charges,32% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,110.55,67,,,percent of total billed charges,67% of total billed charges,110.55,67,,,percent of total billed charges,67% of total billed charges,117.15,71,,,percent of total billed charges,71% of total billed charges,125.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,54.38,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,148.5,90,,,percent of total billed charges,90% of total billed charges,148.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,146.19,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,52.8,32,,,percent of total billed charges,32% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,132,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,150.15,91,,,percent of total billed charges,91% of total billed charges,53.86,32.64,,,percent of total billed charges,32.64% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,55.44,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,52.8,32,,,percent of total billed charges,32% of total billed charges,52.8,32,,,percent of total billed charges,32% of total billed charges,151.8,92,,,percent of total billed charges,92% of total billed charges,34.98,151.8,
EXT ELBOW 2V BILAT,4000198,CDM,320,RC,73070,HCPCS,Outpatient,,,305,259.25,,247.66,81.2,,,percent of total billed charges,81.2% of total billed charges,99.55,32.64,,,percent of total billed charges,32.64% of total billed charges,225.7,74,,,percent of total billed charges,74% of total billed charges,225.7,74,,,percent of total billed charges,74% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,204.35,67,,,percent of total billed charges,67% of total billed charges,204.35,67,,,percent of total billed charges,67% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,231.8,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.53,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,274.5,90,,,percent of total billed charges,90% of total billed charges,274.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,270.23,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,277.55,91,,,percent of total billed charges,91% of total billed charges,99.55,32.64,,,percent of total billed charges,32.64% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,102.48,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,280.6,92,,,percent of total billed charges,92% of total billed charges,34.98,280.6,
EXT ELBOW MIN 3V LT,4000217,CDM,320,RC,73080,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,34.98,197.8,
EXT ELBOW MIN 3V RT,4000218,CDM,320,RC,73080,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,34.98,197.8,
EXT ELBOW MIN 3V BILAT,4000247,CDM,320,RC,73080,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
EXT FOREARM 1V LT,4000234,CDM,320,RC,73090,HCPCS,Outpatient,,,114,96.9,,92.57,81.2,,,percent of total billed charges,81.2% of total billed charges,37.21,32.64,,,percent of total billed charges,32.64% of total billed charges,84.36,74,,,percent of total billed charges,74% of total billed charges,84.36,74,,,percent of total billed charges,74% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,76.38,67,,,percent of total billed charges,67% of total billed charges,76.38,67,,,percent of total billed charges,67% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,86.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,37.57,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,101,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,91.2,80,,,percent of total billed charges,80% of total billed charges,91.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,103.74,91,,,percent of total billed charges,91% of total billed charges,37.21,32.64,,,percent of total billed charges,32.64% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,38.3,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,104.88,92,,,percent of total billed charges,92% of total billed charges,34.98,104.88,
EXT FOREARM 1V RT,4000235,CDM,320,RC,73090,HCPCS,Outpatient,,,114,96.9,,92.57,81.2,,,percent of total billed charges,81.2% of total billed charges,37.21,32.64,,,percent of total billed charges,32.64% of total billed charges,84.36,74,,,percent of total billed charges,74% of total billed charges,84.36,74,,,percent of total billed charges,74% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,76.38,67,,,percent of total billed charges,67% of total billed charges,76.38,67,,,percent of total billed charges,67% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,86.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,37.57,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,101,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,91.2,80,,,percent of total billed charges,80% of total billed charges,91.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,103.74,91,,,percent of total billed charges,91% of total billed charges,37.21,32.64,,,percent of total billed charges,32.64% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,38.3,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,104.88,92,,,percent of total billed charges,92% of total billed charges,34.98,104.88,
EXT FOREARM 1V BILAT,4000248,CDM,320,RC,73090,HCPCS,Outpatient,,,208,176.8,,168.9,81.2,,,percent of total billed charges,81.2% of total billed charges,67.89,32.64,,,percent of total billed charges,32.64% of total billed charges,153.92,74,,,percent of total billed charges,74% of total billed charges,153.92,74,,,percent of total billed charges,74% of total billed charges,66.56,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,66.56,32,,,percent of total billed charges,32% of total billed charges,147.68,71,,,percent of total billed charges,71% of total billed charges,147.68,71,,,percent of total billed charges,71% of total billed charges,139.36,67,,,percent of total billed charges,67% of total billed charges,139.36,67,,,percent of total billed charges,67% of total billed charges,147.68,71,,,percent of total billed charges,71% of total billed charges,158.08,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.56,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,184.29,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,66.56,32,,,percent of total billed charges,32% of total billed charges,166.4,80,,,percent of total billed charges,80% of total billed charges,166.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,189.28,91,,,percent of total billed charges,91% of total billed charges,67.89,32.64,,,percent of total billed charges,32.64% of total billed charges,66.56,32,,,percent of total billed charges,32% of total billed charges,69.89,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,66.56,32,,,percent of total billed charges,32% of total billed charges,66.56,32,,,percent of total billed charges,32% of total billed charges,191.36,92,,,percent of total billed charges,92% of total billed charges,34.98,191.36,
EXT FOREARM 2V LT,4000139,CDM,320,RC,73090,HCPCS,Outpatient,,,227,192.95,,184.32,81.2,,,percent of total billed charges,81.2% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,172.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.82,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,201.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.57,91,,,percent of total billed charges,91% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,76.27,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,208.84,92,,,percent of total billed charges,92% of total billed charges,34.98,208.84,
EXT FOREARM 2V RT,4000178,CDM,320,RC,73090,HCPCS,Outpatient,,,227,192.95,,184.32,81.2,,,percent of total billed charges,81.2% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,167.98,74,,,percent of total billed charges,74% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,152.09,67,,,percent of total billed charges,67% of total billed charges,161.17,71,,,percent of total billed charges,71% of total billed charges,172.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.82,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,201.12,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,181.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.57,91,,,percent of total billed charges,91% of total billed charges,74.09,32.64,,,percent of total billed charges,32.64% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,76.27,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,72.64,32,,,percent of total billed charges,32% of total billed charges,72.64,32,,,percent of total billed charges,32% of total billed charges,208.84,92,,,percent of total billed charges,92% of total billed charges,34.98,208.84,
EXT FOREARM 2V BILAT,4000201,CDM,320,RC,73090,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
EXT UP INFANT MIN 2V LT,4000384,CDM,320,RC,73092,HCPCS,Outpatient,,,246,209.1,,199.75,81.2,,,percent of total billed charges,81.2% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,186.96,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.08,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,217.96,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,223.86,91,,,percent of total billed charges,91% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,82.66,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,226.32,92,,,percent of total billed charges,92% of total billed charges,34.98,226.32,
EXT UP INFANT MIN 2V RT,4000383,CDM,320,RC,73092,HCPCS,Outpatient,,,246,209.1,,199.75,81.2,,,percent of total billed charges,81.2% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,186.96,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.08,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,217.96,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,223.86,91,,,percent of total billed charges,91% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,82.66,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,226.32,92,,,percent of total billed charges,92% of total billed charges,34.98,226.32,
EXT UP INFANT MIN 2V BILAT,4000385,CDM,320,RC,73092,HCPCS,Outpatient,,,369,313.65,,299.63,81.2,,,percent of total billed charges,81.2% of total billed charges,120.44,32.64,,,percent of total billed charges,32.64% of total billed charges,273.06,74,,,percent of total billed charges,74% of total billed charges,273.06,74,,,percent of total billed charges,74% of total billed charges,118.08,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,118.08,32,,,percent of total billed charges,32% of total billed charges,261.99,71,,,percent of total billed charges,71% of total billed charges,261.99,71,,,percent of total billed charges,71% of total billed charges,247.23,67,,,percent of total billed charges,67% of total billed charges,247.23,67,,,percent of total billed charges,67% of total billed charges,261.99,71,,,percent of total billed charges,71% of total billed charges,280.44,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,121.62,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,332.1,90,,,percent of total billed charges,90% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,326.93,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,118.08,32,,,percent of total billed charges,32% of total billed charges,295.2,80,,,percent of total billed charges,80% of total billed charges,295.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,335.79,91,,,percent of total billed charges,91% of total billed charges,120.44,32.64,,,percent of total billed charges,32.64% of total billed charges,118.08,32,,,percent of total billed charges,32% of total billed charges,123.98,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,118.08,32,,,percent of total billed charges,32% of total billed charges,118.08,32,,,percent of total billed charges,32% of total billed charges,339.48,92,,,percent of total billed charges,92% of total billed charges,34.98,339.48,
EXT WRIST 1V LT,4000255,CDM,320,RC,73100,HCPCS,Outpatient,,,120,102,,97.44,81.2,,,percent of total billed charges,81.2% of total billed charges,39.17,32.64,,,percent of total billed charges,32.64% of total billed charges,88.8,74,,,percent of total billed charges,74% of total billed charges,88.8,74,,,percent of total billed charges,74% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,80.4,67,,,percent of total billed charges,67% of total billed charges,80.4,67,,,percent of total billed charges,67% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,91.2,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,39.55,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,106.32,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,96,80,,,percent of total billed charges,80% of total billed charges,96,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,109.2,91,,,percent of total billed charges,91% of total billed charges,39.17,32.64,,,percent of total billed charges,32.64% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,40.32,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,110.4,92,,,percent of total billed charges,92% of total billed charges,34.98,110.4,
EXT WRIST 1V RT,4000254,CDM,320,RC,73100,HCPCS,Outpatient,,,120,102,,97.44,81.2,,,percent of total billed charges,81.2% of total billed charges,39.17,32.64,,,percent of total billed charges,32.64% of total billed charges,88.8,74,,,percent of total billed charges,74% of total billed charges,88.8,74,,,percent of total billed charges,74% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,80.4,67,,,percent of total billed charges,67% of total billed charges,80.4,67,,,percent of total billed charges,67% of total billed charges,85.2,71,,,percent of total billed charges,71% of total billed charges,91.2,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,39.55,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,106.32,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,96,80,,,percent of total billed charges,80% of total billed charges,96,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,109.2,91,,,percent of total billed charges,91% of total billed charges,39.17,32.64,,,percent of total billed charges,32.64% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,40.32,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,38.4,32,,,percent of total billed charges,32% of total billed charges,38.4,32,,,percent of total billed charges,32% of total billed charges,110.4,92,,,percent of total billed charges,92% of total billed charges,34.98,110.4,
EXT WRIST 1V BILAT,4000256,CDM,320,RC,73100,HCPCS,Outpatient,,,245,208.25,,198.94,81.2,,,percent of total billed charges,81.2% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,186.2,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,80.75,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,220.5,90,,,percent of total billed charges,90% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,217.07,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,222.95,91,,,percent of total billed charges,91% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,82.32,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,225.4,92,,,percent of total billed charges,92% of total billed charges,34.98,225.4,
EXT WRIST 2V LT,4000260,CDM,320,RC,73100,HCPCS,Outpatient,,,257,218.45,,208.68,81.2,,,percent of total billed charges,81.2% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,195.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.71,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,227.7,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,233.87,91,,,percent of total billed charges,91% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,86.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,236.44,92,,,percent of total billed charges,92% of total billed charges,34.98,236.44,
EXT WRIST 2V RT,4000259,CDM,320,RC,73100,HCPCS,Outpatient,,,257,218.45,,208.68,81.2,,,percent of total billed charges,81.2% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,195.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.71,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,227.7,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,233.87,91,,,percent of total billed charges,91% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,86.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,236.44,92,,,percent of total billed charges,92% of total billed charges,34.98,236.44,
EXT WRIST 2V BILAT,4000261,CDM,320,RC,73100,HCPCS,Outpatient,,,278,236.3,,225.74,81.2,,,percent of total billed charges,81.2% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,205.72,74,,,percent of total billed charges,74% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,186.26,67,,,percent of total billed charges,67% of total billed charges,197.38,71,,,percent of total billed charges,71% of total billed charges,211.28,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.63,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,250.2,90,,,percent of total billed charges,90% of total billed charges,250.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,246.31,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,222.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.98,91,,,percent of total billed charges,91% of total billed charges,90.74,32.64,,,percent of total billed charges,32.64% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,93.41,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.96,32,,,percent of total billed charges,32% of total billed charges,88.96,32,,,percent of total billed charges,32% of total billed charges,255.76,92,,,percent of total billed charges,92% of total billed charges,34.98,255.76,
EXT WRIST MIN 3V LT,4000160,CDM,320,RC,73110,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
EXT WRIST MIN 3V RT,4000189,CDM,320,RC,73110,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
EXT WRIST MIN 3V BILAT,4000102,CDM,320,RC,73110,HCPCS,Outpatient,,,358,304.3,,290.7,81.2,,,percent of total billed charges,81.2% of total billed charges,116.85,32.64,,,percent of total billed charges,32.64% of total billed charges,264.92,74,,,percent of total billed charges,74% of total billed charges,264.92,74,,,percent of total billed charges,74% of total billed charges,114.56,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,114.56,32,,,percent of total billed charges,32% of total billed charges,254.18,71,,,percent of total billed charges,71% of total billed charges,254.18,71,,,percent of total billed charges,71% of total billed charges,239.86,67,,,percent of total billed charges,67% of total billed charges,239.86,67,,,percent of total billed charges,67% of total billed charges,254.18,71,,,percent of total billed charges,71% of total billed charges,272.08,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,118,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,322.2,90,,,percent of total billed charges,90% of total billed charges,322.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,317.19,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,114.56,32,,,percent of total billed charges,32% of total billed charges,286.4,80,,,percent of total billed charges,80% of total billed charges,286.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,325.78,91,,,percent of total billed charges,91% of total billed charges,116.85,32.64,,,percent of total billed charges,32.64% of total billed charges,114.56,32,,,percent of total billed charges,32% of total billed charges,120.29,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,114.56,32,,,percent of total billed charges,32% of total billed charges,114.56,32,,,percent of total billed charges,32% of total billed charges,329.36,92,,,percent of total billed charges,92% of total billed charges,34.98,329.36,
EXT HAND 2V LT,4000251,CDM,320,RC,73120,HCPCS,Outpatient,,,257,218.45,,208.68,81.2,,,percent of total billed charges,81.2% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,195.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.71,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,227.7,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,233.87,91,,,percent of total billed charges,91% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,86.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,236.44,92,,,percent of total billed charges,92% of total billed charges,34.98,236.44,
EXT HAND 2V RT,4000250,CDM,320,RC,73120,HCPCS,Outpatient,,,257,218.45,,208.68,81.2,,,percent of total billed charges,81.2% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,195.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.71,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,227.7,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,233.87,91,,,percent of total billed charges,91% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,86.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,236.44,92,,,percent of total billed charges,92% of total billed charges,34.98,236.44,
EXT HAND 2V BILAT,4000252,CDM,320,RC,73120,HCPCS,Outpatient,,,276,234.6,,224.11,81.2,,,percent of total billed charges,81.2% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,204.24,74,,,percent of total billed charges,74% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,184.92,67,,,percent of total billed charges,67% of total billed charges,195.96,71,,,percent of total billed charges,71% of total billed charges,209.76,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,90.97,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,248.4,90,,,percent of total billed charges,90% of total billed charges,248.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,244.54,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,220.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,251.16,91,,,percent of total billed charges,91% of total billed charges,90.09,32.64,,,percent of total billed charges,32.64% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,92.74,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,88.32,32,,,percent of total billed charges,32% of total billed charges,88.32,32,,,percent of total billed charges,32% of total billed charges,253.92,92,,,percent of total billed charges,92% of total billed charges,34.98,253.92,
EXT HAND 3V LT,4000140,CDM,320,RC,73130,HCPCS,Outpatient,,,327,277.95,,265.52,81.2,,,percent of total billed charges,81.2% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,248.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,107.78,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,289.72,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,297.57,91,,,percent of total billed charges,91% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,109.87,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,300.84,92,,,percent of total billed charges,92% of total billed charges,34.98,300.84,
EXT HAND 3V RT,4000179,CDM,320,RC,73130,HCPCS,Outpatient,,,327,277.95,,265.52,81.2,,,percent of total billed charges,81.2% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,248.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,107.78,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,289.72,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,297.57,91,,,percent of total billed charges,91% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,109.87,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,300.84,92,,,percent of total billed charges,92% of total billed charges,34.98,300.84,
EXT HAND 3V BILAT,4000202,CDM,320,RC,73130,HCPCS,Outpatient,,,383,325.55,,311,81.2,,,percent of total billed charges,81.2% of total billed charges,125.01,32.64,,,percent of total billed charges,32.64% of total billed charges,283.42,74,,,percent of total billed charges,74% of total billed charges,283.42,74,,,percent of total billed charges,74% of total billed charges,122.56,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,122.56,32,,,percent of total billed charges,32% of total billed charges,271.93,71,,,percent of total billed charges,71% of total billed charges,271.93,71,,,percent of total billed charges,71% of total billed charges,256.61,67,,,percent of total billed charges,67% of total billed charges,256.61,67,,,percent of total billed charges,67% of total billed charges,271.93,71,,,percent of total billed charges,71% of total billed charges,291.08,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,126.24,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,344.7,90,,,percent of total billed charges,90% of total billed charges,344.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,339.34,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,122.56,32,,,percent of total billed charges,32% of total billed charges,306.4,80,,,percent of total billed charges,80% of total billed charges,306.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,348.53,91,,,percent of total billed charges,91% of total billed charges,125.01,32.64,,,percent of total billed charges,32.64% of total billed charges,122.56,32,,,percent of total billed charges,32% of total billed charges,128.69,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,122.56,32,,,percent of total billed charges,32% of total billed charges,122.56,32,,,percent of total billed charges,32% of total billed charges,352.36,92,,,percent of total billed charges,92% of total billed charges,34.98,352.36,
EXT FINGER(S) MIN 2V LT,4000307,CDM,320,RC,73140,HCPCS,Outpatient,,,257,218.45,,208.68,81.2,,,percent of total billed charges,81.2% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,195.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.71,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,227.7,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,233.87,91,,,percent of total billed charges,91% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,86.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,236.44,92,,,percent of total billed charges,92% of total billed charges,34.98,236.44,
EXT FINGER(S) MIN 2V RT,4000306,CDM,320,RC,73140,HCPCS,Outpatient,,,257,218.45,,208.68,81.2,,,percent of total billed charges,81.2% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,195.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.71,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,227.7,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,233.87,91,,,percent of total billed charges,91% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,86.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,236.44,92,,,percent of total billed charges,92% of total billed charges,34.98,236.44,
EXT FINGER MIN 2V BILAT,4000326,CDM,320,RC,73140,HCPCS,Outpatient,,,367,311.95,,298,81.2,,,percent of total billed charges,81.2% of total billed charges,119.79,32.64,,,percent of total billed charges,32.64% of total billed charges,271.58,74,,,percent of total billed charges,74% of total billed charges,271.58,74,,,percent of total billed charges,74% of total billed charges,117.44,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,117.44,32,,,percent of total billed charges,32% of total billed charges,260.57,71,,,percent of total billed charges,71% of total billed charges,260.57,71,,,percent of total billed charges,71% of total billed charges,245.89,67,,,percent of total billed charges,67% of total billed charges,245.89,67,,,percent of total billed charges,67% of total billed charges,260.57,71,,,percent of total billed charges,71% of total billed charges,278.92,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,120.96,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,330.3,90,,,percent of total billed charges,90% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,325.16,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,117.44,32,,,percent of total billed charges,32% of total billed charges,293.6,80,,,percent of total billed charges,80% of total billed charges,293.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,333.97,91,,,percent of total billed charges,91% of total billed charges,119.79,32.64,,,percent of total billed charges,32.64% of total billed charges,117.44,32,,,percent of total billed charges,32% of total billed charges,123.31,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,117.44,32,,,percent of total billed charges,32% of total billed charges,117.44,32,,,percent of total billed charges,32% of total billed charges,337.64,92,,,percent of total billed charges,92% of total billed charges,34.98,337.64,
EXT HIP 1V LT,4000231,CDM,320,RC,73501,HCPCS,Outpatient,,,136,115.6,,110.43,81.2,,,percent of total billed charges,81.2% of total billed charges,44.39,32.64,,,percent of total billed charges,32.64% of total billed charges,100.64,74,,,percent of total billed charges,74% of total billed charges,100.64,74,,,percent of total billed charges,74% of total billed charges,43.52,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,43.52,32,,,percent of total billed charges,32% of total billed charges,96.56,71,,,percent of total billed charges,71% of total billed charges,96.56,71,,,percent of total billed charges,71% of total billed charges,91.12,67,,,percent of total billed charges,67% of total billed charges,91.12,67,,,percent of total billed charges,67% of total billed charges,96.56,71,,,percent of total billed charges,71% of total billed charges,103.36,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,44.83,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,122.4,90,,,percent of total billed charges,90% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,120.5,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,43.52,32,,,percent of total billed charges,32% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,123.76,91,,,percent of total billed charges,91% of total billed charges,44.39,32.64,,,percent of total billed charges,32.64% of total billed charges,43.52,32,,,percent of total billed charges,32% of total billed charges,45.7,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,43.52,32,,,percent of total billed charges,32% of total billed charges,43.52,32,,,percent of total billed charges,32% of total billed charges,125.12,92,,,percent of total billed charges,92% of total billed charges,34.98,125.12,
EXT HIP 1V RT,4000232,CDM,320,RC,73501,HCPCS,Outpatient,,,136,115.6,,110.43,81.2,,,percent of total billed charges,81.2% of total billed charges,44.39,32.64,,,percent of total billed charges,32.64% of total billed charges,100.64,74,,,percent of total billed charges,74% of total billed charges,100.64,74,,,percent of total billed charges,74% of total billed charges,43.52,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,43.52,32,,,percent of total billed charges,32% of total billed charges,96.56,71,,,percent of total billed charges,71% of total billed charges,96.56,71,,,percent of total billed charges,71% of total billed charges,91.12,67,,,percent of total billed charges,67% of total billed charges,91.12,67,,,percent of total billed charges,67% of total billed charges,96.56,71,,,percent of total billed charges,71% of total billed charges,103.36,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,44.83,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,122.4,90,,,percent of total billed charges,90% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,120.5,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,43.52,32,,,percent of total billed charges,32% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,108.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,123.76,91,,,percent of total billed charges,91% of total billed charges,44.39,32.64,,,percent of total billed charges,32.64% of total billed charges,43.52,32,,,percent of total billed charges,32% of total billed charges,45.7,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,43.52,32,,,percent of total billed charges,32% of total billed charges,43.52,32,,,percent of total billed charges,32% of total billed charges,125.12,92,,,percent of total billed charges,92% of total billed charges,34.98,125.12,
PELVIS AND HIP 1V LT,4000163,CDM,320,RC,73501,HCPCS,Outpatient,,,457,388.45,,371.08,81.2,,,percent of total billed charges,81.2% of total billed charges,149.16,32.64,,,percent of total billed charges,32.64% of total billed charges,338.18,74,,,percent of total billed charges,74% of total billed charges,338.18,74,,,percent of total billed charges,74% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,306.19,67,,,percent of total billed charges,67% of total billed charges,306.19,67,,,percent of total billed charges,67% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,347.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,150.63,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,411.3,90,,,percent of total billed charges,90% of total billed charges,411.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,404.9,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,365.6,80,,,percent of total billed charges,80% of total billed charges,365.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,415.87,91,,,percent of total billed charges,91% of total billed charges,149.16,32.64,,,percent of total billed charges,32.64% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,153.55,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,420.44,92,,,percent of total billed charges,92% of total billed charges,34.98,420.44,
PELVIS AND HIP 1V RT,4000191,CDM,320,RC,73501,HCPCS,Outpatient,,,457,388.45,,371.08,81.2,,,percent of total billed charges,81.2% of total billed charges,149.16,32.64,,,percent of total billed charges,32.64% of total billed charges,338.18,74,,,percent of total billed charges,74% of total billed charges,338.18,74,,,percent of total billed charges,74% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,306.19,67,,,percent of total billed charges,67% of total billed charges,306.19,67,,,percent of total billed charges,67% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,347.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,150.63,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,411.3,90,,,percent of total billed charges,90% of total billed charges,411.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,404.9,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,365.6,80,,,percent of total billed charges,80% of total billed charges,365.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,415.87,91,,,percent of total billed charges,91% of total billed charges,149.16,32.64,,,percent of total billed charges,32.64% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,153.55,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,420.44,92,,,percent of total billed charges,92% of total billed charges,34.98,420.44,
EXT HIP 2-3V LT,4000141,CDM,320,RC,73502,HCPCS,Outpatient,,,298,253.3,,241.98,81.2,,,percent of total billed charges,81.2% of total billed charges,97.27,32.64,,,percent of total billed charges,32.64% of total billed charges,220.52,74,,,percent of total billed charges,74% of total billed charges,220.52,74,,,percent of total billed charges,74% of total billed charges,95.36,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.36,32,,,percent of total billed charges,32% of total billed charges,211.58,71,,,percent of total billed charges,71% of total billed charges,211.58,71,,,percent of total billed charges,71% of total billed charges,199.66,67,,,percent of total billed charges,67% of total billed charges,199.66,67,,,percent of total billed charges,67% of total billed charges,211.58,71,,,percent of total billed charges,71% of total billed charges,226.48,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.22,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,264.03,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.36,32,,,percent of total billed charges,32% of total billed charges,238.4,80,,,percent of total billed charges,80% of total billed charges,238.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,271.18,91,,,percent of total billed charges,91% of total billed charges,97.27,32.64,,,percent of total billed charges,32.64% of total billed charges,95.36,32,,,percent of total billed charges,32% of total billed charges,100.13,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.36,32,,,percent of total billed charges,32% of total billed charges,95.36,32,,,percent of total billed charges,32% of total billed charges,274.16,92,,,percent of total billed charges,92% of total billed charges,34.98,274.16,
EXT HIP 2-3V RT,4000180,CDM,320,RC,73502,HCPCS,Outpatient,,,298,253.3,,241.98,81.2,,,percent of total billed charges,81.2% of total billed charges,97.27,32.64,,,percent of total billed charges,32.64% of total billed charges,220.52,74,,,percent of total billed charges,74% of total billed charges,220.52,74,,,percent of total billed charges,74% of total billed charges,95.36,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.36,32,,,percent of total billed charges,32% of total billed charges,211.58,71,,,percent of total billed charges,71% of total billed charges,211.58,71,,,percent of total billed charges,71% of total billed charges,199.66,67,,,percent of total billed charges,67% of total billed charges,199.66,67,,,percent of total billed charges,67% of total billed charges,211.58,71,,,percent of total billed charges,71% of total billed charges,226.48,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.22,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,264.03,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.36,32,,,percent of total billed charges,32% of total billed charges,238.4,80,,,percent of total billed charges,80% of total billed charges,238.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,271.18,91,,,percent of total billed charges,91% of total billed charges,97.27,32.64,,,percent of total billed charges,32.64% of total billed charges,95.36,32,,,percent of total billed charges,32% of total billed charges,100.13,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,95.36,32,,,percent of total billed charges,32% of total billed charges,95.36,32,,,percent of total billed charges,32% of total billed charges,274.16,92,,,percent of total billed charges,92% of total billed charges,34.98,274.16,
PELVIS AND HIP 2-3V LT,4000389,CDM,320,RC,73502,HCPCS,Outpatient,,,457,388.45,,371.08,81.2,,,percent of total billed charges,81.2% of total billed charges,149.16,32.64,,,percent of total billed charges,32.64% of total billed charges,338.18,74,,,percent of total billed charges,74% of total billed charges,338.18,74,,,percent of total billed charges,74% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,306.19,67,,,percent of total billed charges,67% of total billed charges,306.19,67,,,percent of total billed charges,67% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,347.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,150.63,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,411.3,90,,,percent of total billed charges,90% of total billed charges,411.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,404.9,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,365.6,80,,,percent of total billed charges,80% of total billed charges,365.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,415.87,91,,,percent of total billed charges,91% of total billed charges,149.16,32.64,,,percent of total billed charges,32.64% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,153.55,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,420.44,92,,,percent of total billed charges,92% of total billed charges,34.98,420.44,
PELVIS AND HIP 2-3V RT,4000388,CDM,320,RC,73502,HCPCS,Outpatient,,,457,388.45,,371.08,81.2,,,percent of total billed charges,81.2% of total billed charges,149.16,32.64,,,percent of total billed charges,32.64% of total billed charges,338.18,74,,,percent of total billed charges,74% of total billed charges,338.18,74,,,percent of total billed charges,74% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,306.19,67,,,percent of total billed charges,67% of total billed charges,306.19,67,,,percent of total billed charges,67% of total billed charges,324.47,71,,,percent of total billed charges,71% of total billed charges,347.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,150.63,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,411.3,90,,,percent of total billed charges,90% of total billed charges,411.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,404.9,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,365.6,80,,,percent of total billed charges,80% of total billed charges,365.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,415.87,91,,,percent of total billed charges,91% of total billed charges,149.16,32.64,,,percent of total billed charges,32.64% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,153.55,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,146.24,32,,,percent of total billed charges,32% of total billed charges,146.24,32,,,percent of total billed charges,32% of total billed charges,420.44,92,,,percent of total billed charges,92% of total billed charges,34.98,420.44,
PELVIS AND HIPS 2V BILAT,4000115,CDM,320,RC,73521,HCPCS,Outpatient,,,305,259.25,,247.66,81.2,,,percent of total billed charges,81.2% of total billed charges,99.55,32.64,,,percent of total billed charges,32.64% of total billed charges,225.7,74,,,percent of total billed charges,74% of total billed charges,225.7,74,,,percent of total billed charges,74% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,204.35,67,,,percent of total billed charges,67% of total billed charges,204.35,67,,,percent of total billed charges,67% of total billed charges,216.55,71,,,percent of total billed charges,71% of total billed charges,231.8,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.53,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,274.5,90,,,percent of total billed charges,90% of total billed charges,274.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,270.23,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,244,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,277.55,91,,,percent of total billed charges,91% of total billed charges,99.55,32.64,,,percent of total billed charges,32.64% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,102.48,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,97.6,32,,,percent of total billed charges,32% of total billed charges,97.6,32,,,percent of total billed charges,32% of total billed charges,280.6,92,,,percent of total billed charges,92% of total billed charges,34.98,280.6,
EXT FEMUR 1V LT,4000390,CDM,320,RC,73551,HCPCS,Outpatient,,,154,130.9,,125.05,81.2,,,percent of total billed charges,81.2% of total billed charges,50.27,32.64,,,percent of total billed charges,32.64% of total billed charges,113.96,74,,,percent of total billed charges,74% of total billed charges,113.96,74,,,percent of total billed charges,74% of total billed charges,49.28,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,49.28,32,,,percent of total billed charges,32% of total billed charges,109.34,71,,,percent of total billed charges,71% of total billed charges,109.34,71,,,percent of total billed charges,71% of total billed charges,103.18,67,,,percent of total billed charges,67% of total billed charges,103.18,67,,,percent of total billed charges,67% of total billed charges,109.34,71,,,percent of total billed charges,71% of total billed charges,117.04,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,50.76,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,138.6,90,,,percent of total billed charges,90% of total billed charges,138.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,136.44,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,49.28,32,,,percent of total billed charges,32% of total billed charges,123.2,80,,,percent of total billed charges,80% of total billed charges,123.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,140.14,91,,,percent of total billed charges,91% of total billed charges,50.27,32.64,,,percent of total billed charges,32.64% of total billed charges,49.28,32,,,percent of total billed charges,32% of total billed charges,51.74,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,49.28,32,,,percent of total billed charges,32% of total billed charges,49.28,32,,,percent of total billed charges,32% of total billed charges,141.68,92,,,percent of total billed charges,92% of total billed charges,34.98,141.68,
EXT FEMUR 1V RT,4000391,CDM,320,RC,73551,HCPCS,Outpatient,,,154,130.9,,125.05,81.2,,,percent of total billed charges,81.2% of total billed charges,50.27,32.64,,,percent of total billed charges,32.64% of total billed charges,113.96,74,,,percent of total billed charges,74% of total billed charges,113.96,74,,,percent of total billed charges,74% of total billed charges,49.28,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,49.28,32,,,percent of total billed charges,32% of total billed charges,109.34,71,,,percent of total billed charges,71% of total billed charges,109.34,71,,,percent of total billed charges,71% of total billed charges,103.18,67,,,percent of total billed charges,67% of total billed charges,103.18,67,,,percent of total billed charges,67% of total billed charges,109.34,71,,,percent of total billed charges,71% of total billed charges,117.04,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,50.76,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,138.6,90,,,percent of total billed charges,90% of total billed charges,138.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,136.44,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,49.28,32,,,percent of total billed charges,32% of total billed charges,123.2,80,,,percent of total billed charges,80% of total billed charges,123.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,140.14,91,,,percent of total billed charges,91% of total billed charges,50.27,32.64,,,percent of total billed charges,32.64% of total billed charges,49.28,32,,,percent of total billed charges,32% of total billed charges,51.74,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,49.28,32,,,percent of total billed charges,32% of total billed charges,49.28,32,,,percent of total billed charges,32% of total billed charges,141.68,92,,,percent of total billed charges,92% of total billed charges,34.98,141.68,
EXT FEMUR 1V BILAT,4000242,CDM,320,RC,73551,HCPCS,Outpatient,,,245,208.25,,198.94,81.2,,,percent of total billed charges,81.2% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,181.3,74,,,percent of total billed charges,74% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,164.15,67,,,percent of total billed charges,67% of total billed charges,173.95,71,,,percent of total billed charges,71% of total billed charges,186.2,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,80.75,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,220.5,90,,,percent of total billed charges,90% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,217.07,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,196,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,222.95,91,,,percent of total billed charges,91% of total billed charges,79.97,32.64,,,percent of total billed charges,32.64% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,82.32,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.4,32,,,percent of total billed charges,32% of total billed charges,78.4,32,,,percent of total billed charges,32% of total billed charges,225.4,92,,,percent of total billed charges,92% of total billed charges,34.98,225.4,
EXT FEMUR 2V LT,4000127,CDM,320,RC,73552,HCPCS,Outpatient,,,324,275.4,,263.09,81.2,,,percent of total billed charges,81.2% of total billed charges,105.75,32.64,,,percent of total billed charges,32.64% of total billed charges,239.76,74,,,percent of total billed charges,74% of total billed charges,239.76,74,,,percent of total billed charges,74% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,217.08,67,,,percent of total billed charges,67% of total billed charges,217.08,67,,,percent of total billed charges,67% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,246.24,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.79,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,291.6,90,,,percent of total billed charges,90% of total billed charges,291.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,287.06,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,259.2,80,,,percent of total billed charges,80% of total billed charges,259.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,294.84,91,,,percent of total billed charges,91% of total billed charges,105.75,32.64,,,percent of total billed charges,32.64% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,108.86,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,298.08,92,,,percent of total billed charges,92% of total billed charges,34.98,298.08,
EXT FEMUR 2V RT,4000176,CDM,320,RC,73552,HCPCS,Outpatient,,,324,275.4,,263.09,81.2,,,percent of total billed charges,81.2% of total billed charges,105.75,32.64,,,percent of total billed charges,32.64% of total billed charges,239.76,74,,,percent of total billed charges,74% of total billed charges,239.76,74,,,percent of total billed charges,74% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,217.08,67,,,percent of total billed charges,67% of total billed charges,217.08,67,,,percent of total billed charges,67% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,246.24,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.79,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,291.6,90,,,percent of total billed charges,90% of total billed charges,291.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,287.06,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,259.2,80,,,percent of total billed charges,80% of total billed charges,259.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,294.84,91,,,percent of total billed charges,91% of total billed charges,105.75,32.64,,,percent of total billed charges,32.64% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,108.86,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,298.08,92,,,percent of total billed charges,92% of total billed charges,34.98,298.08,
EXT FEMUR 2V BILAT,4000199,CDM,320,RC,73552,HCPCS,Outpatient,,,452,384.2,,367.02,81.2,,,percent of total billed charges,81.2% of total billed charges,147.53,32.64,,,percent of total billed charges,32.64% of total billed charges,334.48,74,,,percent of total billed charges,74% of total billed charges,334.48,74,,,percent of total billed charges,74% of total billed charges,144.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,144.64,32,,,percent of total billed charges,32% of total billed charges,320.92,71,,,percent of total billed charges,71% of total billed charges,320.92,71,,,percent of total billed charges,71% of total billed charges,302.84,67,,,percent of total billed charges,67% of total billed charges,302.84,67,,,percent of total billed charges,67% of total billed charges,320.92,71,,,percent of total billed charges,71% of total billed charges,343.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,148.98,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,406.8,90,,,percent of total billed charges,90% of total billed charges,406.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,400.47,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,144.64,32,,,percent of total billed charges,32% of total billed charges,361.6,80,,,percent of total billed charges,80% of total billed charges,361.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,411.32,91,,,percent of total billed charges,91% of total billed charges,147.53,32.64,,,percent of total billed charges,32.64% of total billed charges,144.64,32,,,percent of total billed charges,32% of total billed charges,151.87,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,144.64,32,,,percent of total billed charges,32% of total billed charges,144.64,32,,,percent of total billed charges,32% of total billed charges,415.84,92,,,percent of total billed charges,92% of total billed charges,34.98,415.84,
EXT KNEE 1-2V LT,4000144,CDM,320,RC,73560,HCPCS,Outpatient,,,324,275.4,,263.09,81.2,,,percent of total billed charges,81.2% of total billed charges,105.75,32.64,,,percent of total billed charges,32.64% of total billed charges,239.76,74,,,percent of total billed charges,74% of total billed charges,239.76,74,,,percent of total billed charges,74% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,217.08,67,,,percent of total billed charges,67% of total billed charges,217.08,67,,,percent of total billed charges,67% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,246.24,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.79,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,291.6,90,,,percent of total billed charges,90% of total billed charges,291.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,287.06,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,259.2,80,,,percent of total billed charges,80% of total billed charges,259.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,294.84,91,,,percent of total billed charges,91% of total billed charges,105.75,32.64,,,percent of total billed charges,32.64% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,108.86,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,298.08,92,,,percent of total billed charges,92% of total billed charges,34.98,298.08,
EXT KNEE 1-2V RT,4000183,CDM,320,RC,73560,HCPCS,Outpatient,,,324,275.4,,263.09,81.2,,,percent of total billed charges,81.2% of total billed charges,105.75,32.64,,,percent of total billed charges,32.64% of total billed charges,239.76,74,,,percent of total billed charges,74% of total billed charges,239.76,74,,,percent of total billed charges,74% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,217.08,67,,,percent of total billed charges,67% of total billed charges,217.08,67,,,percent of total billed charges,67% of total billed charges,230.04,71,,,percent of total billed charges,71% of total billed charges,246.24,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.79,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,291.6,90,,,percent of total billed charges,90% of total billed charges,291.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,287.06,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,259.2,80,,,percent of total billed charges,80% of total billed charges,259.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,294.84,91,,,percent of total billed charges,91% of total billed charges,105.75,32.64,,,percent of total billed charges,32.64% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,108.86,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.68,32,,,percent of total billed charges,32% of total billed charges,103.68,32,,,percent of total billed charges,32% of total billed charges,298.08,92,,,percent of total billed charges,92% of total billed charges,34.98,298.08,
EXT KNEE 1-2V BILAT,4000205,CDM,320,RC,73560,HCPCS,Outpatient,,,486,413.1,,394.63,81.2,,,percent of total billed charges,81.2% of total billed charges,158.63,32.64,,,percent of total billed charges,32.64% of total billed charges,359.64,74,,,percent of total billed charges,74% of total billed charges,359.64,74,,,percent of total billed charges,74% of total billed charges,155.52,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,155.52,32,,,percent of total billed charges,32% of total billed charges,345.06,71,,,percent of total billed charges,71% of total billed charges,345.06,71,,,percent of total billed charges,71% of total billed charges,325.62,67,,,percent of total billed charges,67% of total billed charges,325.62,67,,,percent of total billed charges,67% of total billed charges,345.06,71,,,percent of total billed charges,71% of total billed charges,369.36,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,160.19,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,437.4,90,,,percent of total billed charges,90% of total billed charges,437.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,430.6,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,155.52,32,,,percent of total billed charges,32% of total billed charges,388.8,80,,,percent of total billed charges,80% of total billed charges,388.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,442.26,91,,,percent of total billed charges,91% of total billed charges,158.63,32.64,,,percent of total billed charges,32.64% of total billed charges,155.52,32,,,percent of total billed charges,32% of total billed charges,163.3,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,155.52,32,,,percent of total billed charges,32% of total billed charges,155.52,32,,,percent of total billed charges,32% of total billed charges,447.12,92,,,percent of total billed charges,92% of total billed charges,34.98,447.12,
EXT KNEE 3V LT,4000143,CDM,320,RC,73562,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
EXT KNEE 3V RT,4000182,CDM,320,RC,73562,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
EXT KNEE 3V BILAT,4000204,CDM,320,RC,73562,HCPCS,Outpatient,,,358,304.3,,290.7,81.2,,,percent of total billed charges,81.2% of total billed charges,116.85,32.64,,,percent of total billed charges,32.64% of total billed charges,264.92,74,,,percent of total billed charges,74% of total billed charges,264.92,74,,,percent of total billed charges,74% of total billed charges,114.56,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,114.56,32,,,percent of total billed charges,32% of total billed charges,254.18,71,,,percent of total billed charges,71% of total billed charges,254.18,71,,,percent of total billed charges,71% of total billed charges,239.86,67,,,percent of total billed charges,67% of total billed charges,239.86,67,,,percent of total billed charges,67% of total billed charges,254.18,71,,,percent of total billed charges,71% of total billed charges,272.08,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,118,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,322.2,90,,,percent of total billed charges,90% of total billed charges,322.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,317.19,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,114.56,32,,,percent of total billed charges,32% of total billed charges,286.4,80,,,percent of total billed charges,80% of total billed charges,286.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,325.78,91,,,percent of total billed charges,91% of total billed charges,116.85,32.64,,,percent of total billed charges,32.64% of total billed charges,114.56,32,,,percent of total billed charges,32% of total billed charges,120.29,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,114.56,32,,,percent of total billed charges,32% of total billed charges,114.56,32,,,percent of total billed charges,32% of total billed charges,329.36,92,,,percent of total billed charges,92% of total billed charges,34.98,329.36,
EXT KNEE 4V OR > LT,4000245,CDM,320,RC,73564,HCPCS,Outpatient,,,442,375.7,,358.9,81.2,,,percent of total billed charges,81.2% of total billed charges,144.27,32.64,,,percent of total billed charges,32.64% of total billed charges,327.08,74,,,percent of total billed charges,74% of total billed charges,327.08,74,,,percent of total billed charges,74% of total billed charges,141.44,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,141.44,32,,,percent of total billed charges,32% of total billed charges,313.82,71,,,percent of total billed charges,71% of total billed charges,313.82,71,,,percent of total billed charges,71% of total billed charges,296.14,67,,,percent of total billed charges,67% of total billed charges,296.14,67,,,percent of total billed charges,67% of total billed charges,313.82,71,,,percent of total billed charges,71% of total billed charges,335.92,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,145.68,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,397.8,90,,,percent of total billed charges,90% of total billed charges,397.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,391.61,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,141.44,32,,,percent of total billed charges,32% of total billed charges,353.6,80,,,percent of total billed charges,80% of total billed charges,353.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,402.22,91,,,percent of total billed charges,91% of total billed charges,144.27,32.64,,,percent of total billed charges,32.64% of total billed charges,141.44,32,,,percent of total billed charges,32% of total billed charges,148.51,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,141.44,32,,,percent of total billed charges,32% of total billed charges,141.44,32,,,percent of total billed charges,32% of total billed charges,406.64,92,,,percent of total billed charges,92% of total billed charges,34.98,406.64,
EXT KNEE 4V OR > RT,4000244,CDM,320,RC,73564,HCPCS,Outpatient,,,442,375.7,,358.9,81.2,,,percent of total billed charges,81.2% of total billed charges,144.27,32.64,,,percent of total billed charges,32.64% of total billed charges,327.08,74,,,percent of total billed charges,74% of total billed charges,327.08,74,,,percent of total billed charges,74% of total billed charges,141.44,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,141.44,32,,,percent of total billed charges,32% of total billed charges,313.82,71,,,percent of total billed charges,71% of total billed charges,313.82,71,,,percent of total billed charges,71% of total billed charges,296.14,67,,,percent of total billed charges,67% of total billed charges,296.14,67,,,percent of total billed charges,67% of total billed charges,313.82,71,,,percent of total billed charges,71% of total billed charges,335.92,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,145.68,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,397.8,90,,,percent of total billed charges,90% of total billed charges,397.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,391.61,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,141.44,32,,,percent of total billed charges,32% of total billed charges,353.6,80,,,percent of total billed charges,80% of total billed charges,353.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,402.22,91,,,percent of total billed charges,91% of total billed charges,144.27,32.64,,,percent of total billed charges,32.64% of total billed charges,141.44,32,,,percent of total billed charges,32% of total billed charges,148.51,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,141.44,32,,,percent of total billed charges,32% of total billed charges,141.44,32,,,percent of total billed charges,32% of total billed charges,406.64,92,,,percent of total billed charges,92% of total billed charges,34.98,406.64,
EXT KNEE 4V OR > BIL,4000246,CDM,320,RC,73564,HCPCS,Outpatient,,,520,442,,422.24,81.2,,,percent of total billed charges,81.2% of total billed charges,169.73,32.64,,,percent of total billed charges,32.64% of total billed charges,384.8,74,,,percent of total billed charges,74% of total billed charges,384.8,74,,,percent of total billed charges,74% of total billed charges,166.4,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,166.4,32,,,percent of total billed charges,32% of total billed charges,369.2,71,,,percent of total billed charges,71% of total billed charges,369.2,71,,,percent of total billed charges,71% of total billed charges,348.4,67,,,percent of total billed charges,67% of total billed charges,348.4,67,,,percent of total billed charges,67% of total billed charges,369.2,71,,,percent of total billed charges,71% of total billed charges,395.2,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,171.39,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,468,90,,,percent of total billed charges,90% of total billed charges,468,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,460.72,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,166.4,32,,,percent of total billed charges,32% of total billed charges,416,80,,,percent of total billed charges,80% of total billed charges,416,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,473.2,91,,,percent of total billed charges,91% of total billed charges,169.73,32.64,,,percent of total billed charges,32.64% of total billed charges,166.4,32,,,percent of total billed charges,32% of total billed charges,174.72,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,166.4,32,,,percent of total billed charges,32% of total billed charges,166.4,32,,,percent of total billed charges,32% of total billed charges,478.4,92,,,percent of total billed charges,92% of total billed charges,34.98,478.4,
EXT KNEE BILAT STANDING AP,4000321,CDM,320,RC,73565,HCPCS,Outpatient,,,309,262.65,,250.91,81.2,,,percent of total billed charges,81.2% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,228.66,74,,,percent of total billed charges,74% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,207.03,67,,,percent of total billed charges,67% of total billed charges,219.39,71,,,percent of total billed charges,71% of total billed charges,234.84,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,101.85,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,273.77,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,247.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,281.19,91,,,percent of total billed charges,91% of total billed charges,100.86,32.64,,,percent of total billed charges,32.64% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,103.82,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,98.88,32,,,percent of total billed charges,32% of total billed charges,98.88,32,,,percent of total billed charges,32% of total billed charges,284.28,92,,,percent of total billed charges,92% of total billed charges,34.98,284.28,
EXT TIB/FIB 1V LT,4000393,CDM,320,RC,73590,HCPCS,Outpatient,,,222,188.7,,180.26,81.2,,,percent of total billed charges,81.2% of total billed charges,72.46,32.64,,,percent of total billed charges,32.64% of total billed charges,164.28,74,,,percent of total billed charges,74% of total billed charges,164.28,74,,,percent of total billed charges,74% of total billed charges,71.04,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,71.04,32,,,percent of total billed charges,32% of total billed charges,157.62,71,,,percent of total billed charges,71% of total billed charges,157.62,71,,,percent of total billed charges,71% of total billed charges,148.74,67,,,percent of total billed charges,67% of total billed charges,148.74,67,,,percent of total billed charges,67% of total billed charges,157.62,71,,,percent of total billed charges,71% of total billed charges,168.72,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,73.17,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,199.8,90,,,percent of total billed charges,90% of total billed charges,199.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,196.69,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,71.04,32,,,percent of total billed charges,32% of total billed charges,177.6,80,,,percent of total billed charges,80% of total billed charges,177.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,202.02,91,,,percent of total billed charges,91% of total billed charges,72.46,32.64,,,percent of total billed charges,32.64% of total billed charges,71.04,32,,,percent of total billed charges,32% of total billed charges,74.59,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,71.04,32,,,percent of total billed charges,32% of total billed charges,71.04,32,,,percent of total billed charges,32% of total billed charges,204.24,92,,,percent of total billed charges,92% of total billed charges,34.98,204.24,
EXT TIB/FIB 1V RT,4000392,CDM,320,RC,73590,HCPCS,Outpatient,,,222,188.7,,180.26,81.2,,,percent of total billed charges,81.2% of total billed charges,72.46,32.64,,,percent of total billed charges,32.64% of total billed charges,164.28,74,,,percent of total billed charges,74% of total billed charges,164.28,74,,,percent of total billed charges,74% of total billed charges,71.04,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,71.04,32,,,percent of total billed charges,32% of total billed charges,157.62,71,,,percent of total billed charges,71% of total billed charges,157.62,71,,,percent of total billed charges,71% of total billed charges,148.74,67,,,percent of total billed charges,67% of total billed charges,148.74,67,,,percent of total billed charges,67% of total billed charges,157.62,71,,,percent of total billed charges,71% of total billed charges,168.72,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,73.17,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,199.8,90,,,percent of total billed charges,90% of total billed charges,199.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,196.69,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,71.04,32,,,percent of total billed charges,32% of total billed charges,177.6,80,,,percent of total billed charges,80% of total billed charges,177.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,202.02,91,,,percent of total billed charges,91% of total billed charges,72.46,32.64,,,percent of total billed charges,32.64% of total billed charges,71.04,32,,,percent of total billed charges,32% of total billed charges,74.59,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,71.04,32,,,percent of total billed charges,32% of total billed charges,71.04,32,,,percent of total billed charges,32% of total billed charges,204.24,92,,,percent of total billed charges,92% of total billed charges,34.98,204.24,
EXT TIB/FIB 2V LT,4000145,CDM,320,RC,73590,HCPCS,Outpatient,,,243,206.55,,197.32,81.2,,,percent of total billed charges,81.2% of total billed charges,79.32,32.64,,,percent of total billed charges,32.64% of total billed charges,179.82,74,,,percent of total billed charges,74% of total billed charges,179.82,74,,,percent of total billed charges,74% of total billed charges,77.76,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,77.76,32,,,percent of total billed charges,32% of total billed charges,172.53,71,,,percent of total billed charges,71% of total billed charges,172.53,71,,,percent of total billed charges,71% of total billed charges,162.81,67,,,percent of total billed charges,67% of total billed charges,162.81,67,,,percent of total billed charges,67% of total billed charges,172.53,71,,,percent of total billed charges,71% of total billed charges,184.68,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,80.09,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,218.7,90,,,percent of total billed charges,90% of total billed charges,218.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,215.3,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,77.76,32,,,percent of total billed charges,32% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,221.13,91,,,percent of total billed charges,91% of total billed charges,79.32,32.64,,,percent of total billed charges,32.64% of total billed charges,77.76,32,,,percent of total billed charges,32% of total billed charges,81.65,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,77.76,32,,,percent of total billed charges,32% of total billed charges,77.76,32,,,percent of total billed charges,32% of total billed charges,223.56,92,,,percent of total billed charges,92% of total billed charges,34.98,223.56,
EXT TIB/FIB 2V RT,4000184,CDM,320,RC,73590,HCPCS,Outpatient,,,243,206.55,,197.32,81.2,,,percent of total billed charges,81.2% of total billed charges,79.32,32.64,,,percent of total billed charges,32.64% of total billed charges,179.82,74,,,percent of total billed charges,74% of total billed charges,179.82,74,,,percent of total billed charges,74% of total billed charges,77.76,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,77.76,32,,,percent of total billed charges,32% of total billed charges,172.53,71,,,percent of total billed charges,71% of total billed charges,172.53,71,,,percent of total billed charges,71% of total billed charges,162.81,67,,,percent of total billed charges,67% of total billed charges,162.81,67,,,percent of total billed charges,67% of total billed charges,172.53,71,,,percent of total billed charges,71% of total billed charges,184.68,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,80.09,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,218.7,90,,,percent of total billed charges,90% of total billed charges,218.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,215.3,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,77.76,32,,,percent of total billed charges,32% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,194.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,221.13,91,,,percent of total billed charges,91% of total billed charges,79.32,32.64,,,percent of total billed charges,32.64% of total billed charges,77.76,32,,,percent of total billed charges,32% of total billed charges,81.65,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,77.76,32,,,percent of total billed charges,32% of total billed charges,77.76,32,,,percent of total billed charges,32% of total billed charges,223.56,92,,,percent of total billed charges,92% of total billed charges,34.98,223.56,
EXT TIB/FIB 1V BILAT,4000243,CDM,320,RC,73590,HCPCS,Outpatient,,,334,283.9,,271.21,81.2,,,percent of total billed charges,81.2% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,253.84,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,110.09,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,295.92,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,303.94,91,,,percent of total billed charges,91% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,112.22,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,307.28,92,,,percent of total billed charges,92% of total billed charges,34.98,307.28,
EXT TIB/FIB 2V BILAT,4000210,CDM,320,RC,73590,HCPCS,Outpatient,,,364,309.4,,295.57,81.2,,,percent of total billed charges,81.2% of total billed charges,118.81,32.64,,,percent of total billed charges,32.64% of total billed charges,269.36,74,,,percent of total billed charges,74% of total billed charges,269.36,74,,,percent of total billed charges,74% of total billed charges,116.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,116.48,32,,,percent of total billed charges,32% of total billed charges,258.44,71,,,percent of total billed charges,71% of total billed charges,258.44,71,,,percent of total billed charges,71% of total billed charges,243.88,67,,,percent of total billed charges,67% of total billed charges,243.88,67,,,percent of total billed charges,67% of total billed charges,258.44,71,,,percent of total billed charges,71% of total billed charges,276.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,119.97,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,327.6,90,,,percent of total billed charges,90% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,322.5,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,116.48,32,,,percent of total billed charges,32% of total billed charges,291.2,80,,,percent of total billed charges,80% of total billed charges,291.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,331.24,91,,,percent of total billed charges,91% of total billed charges,118.81,32.64,,,percent of total billed charges,32.64% of total billed charges,116.48,32,,,percent of total billed charges,32% of total billed charges,122.3,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,116.48,32,,,percent of total billed charges,32% of total billed charges,116.48,32,,,percent of total billed charges,32% of total billed charges,334.88,92,,,percent of total billed charges,92% of total billed charges,34.98,334.88,
EXT LOW INFANT MIN 2V LT,4000309,CDM,320,RC,73592,HCPCS,Outpatient,,,246,209.1,,199.75,81.2,,,percent of total billed charges,81.2% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,186.96,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.08,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,217.96,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,223.86,91,,,percent of total billed charges,91% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,82.66,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,226.32,92,,,percent of total billed charges,92% of total billed charges,34.98,226.32,
EXT LOW INFANT MIN 2V RT,4000308,CDM,320,RC,73592,HCPCS,Outpatient,,,246,209.1,,199.75,81.2,,,percent of total billed charges,81.2% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,182.04,74,,,percent of total billed charges,74% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,164.82,67,,,percent of total billed charges,67% of total billed charges,174.66,71,,,percent of total billed charges,71% of total billed charges,186.96,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,81.08,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,217.96,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,196.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,223.86,91,,,percent of total billed charges,91% of total billed charges,80.29,32.64,,,percent of total billed charges,32.64% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,82.66,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,78.72,32,,,percent of total billed charges,32% of total billed charges,78.72,32,,,percent of total billed charges,32% of total billed charges,226.32,92,,,percent of total billed charges,92% of total billed charges,34.98,226.32,
EXT LOW INFANT MIN 2V BILATERAL,4000310,CDM,320,RC,73592,HCPCS,Outpatient,,,369,313.65,,299.63,81.2,,,percent of total billed charges,81.2% of total billed charges,120.44,32.64,,,percent of total billed charges,32.64% of total billed charges,273.06,74,,,percent of total billed charges,74% of total billed charges,273.06,74,,,percent of total billed charges,74% of total billed charges,118.08,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,118.08,32,,,percent of total billed charges,32% of total billed charges,261.99,71,,,percent of total billed charges,71% of total billed charges,261.99,71,,,percent of total billed charges,71% of total billed charges,247.23,67,,,percent of total billed charges,67% of total billed charges,247.23,67,,,percent of total billed charges,67% of total billed charges,261.99,71,,,percent of total billed charges,71% of total billed charges,280.44,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,121.62,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,332.1,90,,,percent of total billed charges,90% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,326.93,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,118.08,32,,,percent of total billed charges,32% of total billed charges,295.2,80,,,percent of total billed charges,80% of total billed charges,295.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,335.79,91,,,percent of total billed charges,91% of total billed charges,120.44,32.64,,,percent of total billed charges,32.64% of total billed charges,118.08,32,,,percent of total billed charges,32% of total billed charges,123.98,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,118.08,32,,,percent of total billed charges,32% of total billed charges,118.08,32,,,percent of total billed charges,32% of total billed charges,339.48,92,,,percent of total billed charges,92% of total billed charges,34.98,339.48,
EXT ANKLE 1V LT,4000237,CDM,320,RC,73600,HCPCS,Outpatient,,,114,96.9,,92.57,81.2,,,percent of total billed charges,81.2% of total billed charges,37.21,32.64,,,percent of total billed charges,32.64% of total billed charges,84.36,74,,,percent of total billed charges,74% of total billed charges,84.36,74,,,percent of total billed charges,74% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,76.38,67,,,percent of total billed charges,67% of total billed charges,76.38,67,,,percent of total billed charges,67% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,86.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,37.57,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,101,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,91.2,80,,,percent of total billed charges,80% of total billed charges,91.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,103.74,91,,,percent of total billed charges,91% of total billed charges,37.21,32.64,,,percent of total billed charges,32.64% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,38.3,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,104.88,92,,,percent of total billed charges,92% of total billed charges,34.98,104.88,
EXT ANKLE 1V RT,4000238,CDM,320,RC,73600,HCPCS,Outpatient,,,114,96.9,,92.57,81.2,,,percent of total billed charges,81.2% of total billed charges,37.21,32.64,,,percent of total billed charges,32.64% of total billed charges,84.36,74,,,percent of total billed charges,74% of total billed charges,84.36,74,,,percent of total billed charges,74% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,76.38,67,,,percent of total billed charges,67% of total billed charges,76.38,67,,,percent of total billed charges,67% of total billed charges,80.94,71,,,percent of total billed charges,71% of total billed charges,86.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,37.57,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,101,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,91.2,80,,,percent of total billed charges,80% of total billed charges,91.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,103.74,91,,,percent of total billed charges,91% of total billed charges,37.21,32.64,,,percent of total billed charges,32.64% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,38.3,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,36.48,32,,,percent of total billed charges,32% of total billed charges,36.48,32,,,percent of total billed charges,32% of total billed charges,104.88,92,,,percent of total billed charges,92% of total billed charges,34.98,104.88,
EXT ANKLE 2V LT,4000215,CDM,320,RC,73600,HCPCS,Outpatient,,,171,145.35,,138.85,81.2,,,percent of total billed charges,81.2% of total billed charges,55.81,32.64,,,percent of total billed charges,32.64% of total billed charges,126.54,74,,,percent of total billed charges,74% of total billed charges,126.54,74,,,percent of total billed charges,74% of total billed charges,54.72,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,54.72,32,,,percent of total billed charges,32% of total billed charges,121.41,71,,,percent of total billed charges,71% of total billed charges,121.41,71,,,percent of total billed charges,71% of total billed charges,114.57,67,,,percent of total billed charges,67% of total billed charges,114.57,67,,,percent of total billed charges,67% of total billed charges,121.41,71,,,percent of total billed charges,71% of total billed charges,129.96,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,56.36,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,153.9,90,,,percent of total billed charges,90% of total billed charges,153.9,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,151.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,54.72,32,,,percent of total billed charges,32% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,155.61,91,,,percent of total billed charges,91% of total billed charges,55.81,32.64,,,percent of total billed charges,32.64% of total billed charges,54.72,32,,,percent of total billed charges,32% of total billed charges,57.46,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,54.72,32,,,percent of total billed charges,32% of total billed charges,54.72,32,,,percent of total billed charges,32% of total billed charges,157.32,92,,,percent of total billed charges,92% of total billed charges,34.98,157.32,
EXT ANKLE 2V RT,4000216,CDM,320,RC,73600,HCPCS,Outpatient,,,171,145.35,,138.85,81.2,,,percent of total billed charges,81.2% of total billed charges,55.81,32.64,,,percent of total billed charges,32.64% of total billed charges,126.54,74,,,percent of total billed charges,74% of total billed charges,126.54,74,,,percent of total billed charges,74% of total billed charges,54.72,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,54.72,32,,,percent of total billed charges,32% of total billed charges,121.41,71,,,percent of total billed charges,71% of total billed charges,121.41,71,,,percent of total billed charges,71% of total billed charges,114.57,67,,,percent of total billed charges,67% of total billed charges,114.57,67,,,percent of total billed charges,67% of total billed charges,121.41,71,,,percent of total billed charges,71% of total billed charges,129.96,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,56.36,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,153.9,90,,,percent of total billed charges,90% of total billed charges,153.9,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,151.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,54.72,32,,,percent of total billed charges,32% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,136.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,155.61,91,,,percent of total billed charges,91% of total billed charges,55.81,32.64,,,percent of total billed charges,32.64% of total billed charges,54.72,32,,,percent of total billed charges,32% of total billed charges,57.46,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,54.72,32,,,percent of total billed charges,32% of total billed charges,54.72,32,,,percent of total billed charges,32% of total billed charges,157.32,92,,,percent of total billed charges,92% of total billed charges,34.98,157.32,
EXT ANKLE 1V BILAT,4000269,CDM,320,RC,73600,HCPCS,Outpatient,,,198,168.3,,160.78,81.2,,,percent of total billed charges,81.2% of total billed charges,64.63,32.64,,,percent of total billed charges,32.64% of total billed charges,146.52,74,,,percent of total billed charges,74% of total billed charges,146.52,74,,,percent of total billed charges,74% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,132.66,67,,,percent of total billed charges,67% of total billed charges,132.66,67,,,percent of total billed charges,67% of total billed charges,140.58,71,,,percent of total billed charges,71% of total billed charges,150.48,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,65.26,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,178.2,90,,,percent of total billed charges,90% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,175.43,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,158.4,80,,,percent of total billed charges,80% of total billed charges,158.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,180.18,91,,,percent of total billed charges,91% of total billed charges,64.63,32.64,,,percent of total billed charges,32.64% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,66.53,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,63.36,32,,,percent of total billed charges,32% of total billed charges,63.36,32,,,percent of total billed charges,32% of total billed charges,182.16,92,,,percent of total billed charges,92% of total billed charges,34.98,182.16,
EXT ANKLE 2V BILAT,4000249,CDM,320,RC,73600,HCPCS,Outpatient,,,252,214.2,,204.62,81.2,,,percent of total billed charges,81.2% of total billed charges,82.25,32.64,,,percent of total billed charges,32.64% of total billed charges,186.48,74,,,percent of total billed charges,74% of total billed charges,186.48,74,,,percent of total billed charges,74% of total billed charges,80.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,80.64,32,,,percent of total billed charges,32% of total billed charges,178.92,71,,,percent of total billed charges,71% of total billed charges,178.92,71,,,percent of total billed charges,71% of total billed charges,168.84,67,,,percent of total billed charges,67% of total billed charges,168.84,67,,,percent of total billed charges,67% of total billed charges,178.92,71,,,percent of total billed charges,71% of total billed charges,191.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,83.06,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,226.8,90,,,percent of total billed charges,90% of total billed charges,226.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,223.27,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,80.64,32,,,percent of total billed charges,32% of total billed charges,201.6,80,,,percent of total billed charges,80% of total billed charges,201.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,229.32,91,,,percent of total billed charges,91% of total billed charges,82.25,32.64,,,percent of total billed charges,32.64% of total billed charges,80.64,32,,,percent of total billed charges,32% of total billed charges,84.67,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,80.64,32,,,percent of total billed charges,32% of total billed charges,80.64,32,,,percent of total billed charges,32% of total billed charges,231.84,92,,,percent of total billed charges,92% of total billed charges,34.98,231.84,
EXT ANKLE MIN 3V LT,4000123,CDM,320,RC,73610,HCPCS,Outpatient,,,233,198.05,,189.2,81.2,,,percent of total billed charges,81.2% of total billed charges,76.05,32.64,,,percent of total billed charges,32.64% of total billed charges,172.42,74,,,percent of total billed charges,74% of total billed charges,172.42,74,,,percent of total billed charges,74% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,156.11,67,,,percent of total billed charges,67% of total billed charges,156.11,67,,,percent of total billed charges,67% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,177.08,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,76.8,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,209.7,90,,,percent of total billed charges,90% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.44,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,212.03,91,,,percent of total billed charges,91% of total billed charges,76.05,32.64,,,percent of total billed charges,32.64% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,78.29,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,214.36,92,,,percent of total billed charges,92% of total billed charges,34.98,214.36,
EXT ANKLE MIN 3V RT,4000172,CDM,320,RC,73610,HCPCS,Outpatient,,,233,198.05,,189.2,81.2,,,percent of total billed charges,81.2% of total billed charges,76.05,32.64,,,percent of total billed charges,32.64% of total billed charges,172.42,74,,,percent of total billed charges,74% of total billed charges,172.42,74,,,percent of total billed charges,74% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,156.11,67,,,percent of total billed charges,67% of total billed charges,156.11,67,,,percent of total billed charges,67% of total billed charges,165.43,71,,,percent of total billed charges,71% of total billed charges,177.08,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,76.8,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,209.7,90,,,percent of total billed charges,90% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,206.44,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,186.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,212.03,91,,,percent of total billed charges,91% of total billed charges,76.05,32.64,,,percent of total billed charges,32.64% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,78.29,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,74.56,32,,,percent of total billed charges,32% of total billed charges,74.56,32,,,percent of total billed charges,32% of total billed charges,214.36,92,,,percent of total billed charges,92% of total billed charges,34.98,214.36,
EXT ANKLE MIN 3V BILAT,4000196,CDM,320,RC,73610,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
EXT FOOT 2V LT,4000219,CDM,320,RC,73620,HCPCS,Outpatient,,,218,185.3,,177.02,81.2,,,percent of total billed charges,81.2% of total billed charges,71.16,32.64,,,percent of total billed charges,32.64% of total billed charges,161.32,74,,,percent of total billed charges,74% of total billed charges,161.32,74,,,percent of total billed charges,74% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,146.06,67,,,percent of total billed charges,67% of total billed charges,146.06,67,,,percent of total billed charges,67% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,165.68,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,71.85,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,196.2,90,,,percent of total billed charges,90% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,193.15,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,174.4,80,,,percent of total billed charges,80% of total billed charges,174.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,198.38,91,,,percent of total billed charges,91% of total billed charges,71.16,32.64,,,percent of total billed charges,32.64% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,73.25,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,200.56,92,,,percent of total billed charges,92% of total billed charges,34.98,200.56,
EXT FOOT 2V RT,4000220,CDM,320,RC,73620,HCPCS,Outpatient,,,218,185.3,,177.02,81.2,,,percent of total billed charges,81.2% of total billed charges,71.16,32.64,,,percent of total billed charges,32.64% of total billed charges,161.32,74,,,percent of total billed charges,74% of total billed charges,161.32,74,,,percent of total billed charges,74% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,146.06,67,,,percent of total billed charges,67% of total billed charges,146.06,67,,,percent of total billed charges,67% of total billed charges,154.78,71,,,percent of total billed charges,71% of total billed charges,165.68,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,71.85,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,196.2,90,,,percent of total billed charges,90% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,193.15,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,174.4,80,,,percent of total billed charges,80% of total billed charges,174.4,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,198.38,91,,,percent of total billed charges,91% of total billed charges,71.16,32.64,,,percent of total billed charges,32.64% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,73.25,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,69.76,32,,,percent of total billed charges,32% of total billed charges,69.76,32,,,percent of total billed charges,32% of total billed charges,200.56,92,,,percent of total billed charges,92% of total billed charges,34.98,200.56,
EXT FOOT 2V BILAT,4000268,CDM,320,RC,73620,HCPCS,Outpatient,,,260,221,,211.12,81.2,,,percent of total billed charges,81.2% of total billed charges,84.86,32.64,,,percent of total billed charges,32.64% of total billed charges,192.4,74,,,percent of total billed charges,74% of total billed charges,192.4,74,,,percent of total billed charges,74% of total billed charges,83.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,83.2,32,,,percent of total billed charges,32% of total billed charges,184.6,71,,,percent of total billed charges,71% of total billed charges,184.6,71,,,percent of total billed charges,71% of total billed charges,174.2,67,,,percent of total billed charges,67% of total billed charges,174.2,67,,,percent of total billed charges,67% of total billed charges,184.6,71,,,percent of total billed charges,71% of total billed charges,197.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,85.7,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,234,90,,,percent of total billed charges,90% of total billed charges,234,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,230.36,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,83.2,32,,,percent of total billed charges,32% of total billed charges,208,80,,,percent of total billed charges,80% of total billed charges,208,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,236.6,91,,,percent of total billed charges,91% of total billed charges,84.86,32.64,,,percent of total billed charges,32.64% of total billed charges,83.2,32,,,percent of total billed charges,32% of total billed charges,87.36,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,83.2,32,,,percent of total billed charges,32% of total billed charges,83.2,32,,,percent of total billed charges,32% of total billed charges,239.2,92,,,percent of total billed charges,92% of total billed charges,34.98,239.2,
EXT FOOT MIN 3V LT,4000138,CDM,320,RC,73630,HCPCS,Outpatient,,,327,277.95,,265.52,81.2,,,percent of total billed charges,81.2% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,248.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,107.78,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,289.72,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,297.57,91,,,percent of total billed charges,91% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,109.87,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,300.84,92,,,percent of total billed charges,92% of total billed charges,34.98,300.84,
EXT FOOT MIN 3V RT,4000177,CDM,320,RC,73630,HCPCS,Outpatient,,,327,277.95,,265.52,81.2,,,percent of total billed charges,81.2% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,241.98,74,,,percent of total billed charges,74% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,219.09,67,,,percent of total billed charges,67% of total billed charges,232.17,71,,,percent of total billed charges,71% of total billed charges,248.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,107.78,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,289.72,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,261.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,297.57,91,,,percent of total billed charges,91% of total billed charges,106.73,32.64,,,percent of total billed charges,32.64% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,109.87,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,104.64,32,,,percent of total billed charges,32% of total billed charges,104.64,32,,,percent of total billed charges,32% of total billed charges,300.84,92,,,percent of total billed charges,92% of total billed charges,34.98,300.84,
EXT FOOT MIN 3V BILAT,4000200,CDM,320,RC,73630,HCPCS,Outpatient,,,355,301.75,,288.26,81.2,,,percent of total billed charges,81.2% of total billed charges,115.87,32.64,,,percent of total billed charges,32.64% of total billed charges,262.7,74,,,percent of total billed charges,74% of total billed charges,262.7,74,,,percent of total billed charges,74% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,237.85,67,,,percent of total billed charges,67% of total billed charges,237.85,67,,,percent of total billed charges,67% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,269.8,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,117.01,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,319.5,90,,,percent of total billed charges,90% of total billed charges,319.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,314.53,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,284,80,,,percent of total billed charges,80% of total billed charges,284,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,323.05,91,,,percent of total billed charges,91% of total billed charges,115.87,32.64,,,percent of total billed charges,32.64% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,119.28,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,326.6,92,,,percent of total billed charges,92% of total billed charges,34.98,326.6,
EXT CALCAN MIN 2V LT,4000124,CDM,320,RC,73650,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,34.98,197.8,
EXT CALCAN MIN 2V RT,4000173,CDM,320,RC,73650,HCPCS,Outpatient,,,215,182.75,,174.58,81.2,,,percent of total billed charges,81.2% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,159.1,74,,,percent of total billed charges,74% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,144.05,67,,,percent of total billed charges,67% of total billed charges,152.65,71,,,percent of total billed charges,71% of total billed charges,163.4,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,70.86,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,190.49,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,172,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,195.65,91,,,percent of total billed charges,91% of total billed charges,70.18,32.64,,,percent of total billed charges,32.64% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,72.24,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,68.8,32,,,percent of total billed charges,32% of total billed charges,68.8,32,,,percent of total billed charges,32% of total billed charges,197.8,92,,,percent of total billed charges,92% of total billed charges,34.98,197.8,
EXT CALCAN MIN 2V BILAT,4000236,CDM,320,RC,73650,HCPCS,Outpatient,,,314,266.9,,254.97,81.2,,,percent of total billed charges,81.2% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,232.36,74,,,percent of total billed charges,74% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,210.38,67,,,percent of total billed charges,67% of total billed charges,222.94,71,,,percent of total billed charges,71% of total billed charges,238.64,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,103.49,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,278.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,251.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,285.74,91,,,percent of total billed charges,91% of total billed charges,102.49,32.64,,,percent of total billed charges,32.64% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,105.5,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,100.48,32,,,percent of total billed charges,32% of total billed charges,100.48,32,,,percent of total billed charges,32% of total billed charges,288.88,92,,,percent of total billed charges,92% of total billed charges,34.98,288.88,
EXT TOE(S) MIN 2V BILAT,4000313,CDM,320,RC,73660,HCPCS,Outpatient,,,162,137.7,,131.54,81.2,,,percent of total billed charges,81.2% of total billed charges,52.88,32.64,,,percent of total billed charges,32.64% of total billed charges,119.88,74,,,percent of total billed charges,74% of total billed charges,119.88,74,,,percent of total billed charges,74% of total billed charges,51.84,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,51.84,32,,,percent of total billed charges,32% of total billed charges,115.02,71,,,percent of total billed charges,71% of total billed charges,115.02,71,,,percent of total billed charges,71% of total billed charges,108.54,67,,,percent of total billed charges,67% of total billed charges,108.54,67,,,percent of total billed charges,67% of total billed charges,115.02,71,,,percent of total billed charges,71% of total billed charges,123.12,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,53.4,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,145.8,90,,,percent of total billed charges,90% of total billed charges,145.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,143.53,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,51.84,32,,,percent of total billed charges,32% of total billed charges,129.6,80,,,percent of total billed charges,80% of total billed charges,129.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,147.42,91,,,percent of total billed charges,91% of total billed charges,52.88,32.64,,,percent of total billed charges,32.64% of total billed charges,51.84,32,,,percent of total billed charges,32% of total billed charges,54.43,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,51.84,32,,,percent of total billed charges,32% of total billed charges,51.84,32,,,percent of total billed charges,32% of total billed charges,149.04,92,,,percent of total billed charges,92% of total billed charges,34.98,149.04,
EXT TOE(S) MIN 2V LT,4000312,CDM,320,RC,73660,HCPCS,Outpatient,,,257,218.45,,208.68,81.2,,,percent of total billed charges,81.2% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,195.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.71,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,227.7,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,233.87,91,,,percent of total billed charges,91% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,86.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,236.44,92,,,percent of total billed charges,92% of total billed charges,34.98,236.44,
EXT TOE(S) MIN 2V RT,4000311,CDM,320,RC,73660,HCPCS,Outpatient,,,257,218.45,,208.68,81.2,,,percent of total billed charges,81.2% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,190.18,74,,,percent of total billed charges,74% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,172.19,67,,,percent of total billed charges,67% of total billed charges,182.47,71,,,percent of total billed charges,71% of total billed charges,195.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,84.71,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,227.7,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,205.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,233.87,91,,,percent of total billed charges,91% of total billed charges,83.88,32.64,,,percent of total billed charges,32.64% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,86.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,82.24,32,,,percent of total billed charges,32% of total billed charges,82.24,32,,,percent of total billed charges,32% of total billed charges,236.44,92,,,percent of total billed charges,92% of total billed charges,34.98,236.44,
ABD 1V,4000063,CDM,320,RC,74018,HCPCS,Outpatient,,,285,242.25,,231.42,81.2,,,percent of total billed charges,81.2% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,210.9,74,,,percent of total billed charges,74% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,190.95,67,,,percent of total billed charges,67% of total billed charges,202.35,71,,,percent of total billed charges,71% of total billed charges,216.6,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,93.94,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,252.51,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,228,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,259.35,91,,,percent of total billed charges,91% of total billed charges,93.02,32.64,,,percent of total billed charges,32.64% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,95.76,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,91.2,32,,,percent of total billed charges,32% of total billed charges,91.2,32,,,percent of total billed charges,32% of total billed charges,262.2,92,,,percent of total billed charges,92% of total billed charges,34.98,262.2,
ABD 2V,4000064,CDM,320,RC,74019,HCPCS,Outpatient,,,355,301.75,,288.26,81.2,,,percent of total billed charges,81.2% of total billed charges,115.87,32.64,,,percent of total billed charges,32.64% of total billed charges,262.7,74,,,percent of total billed charges,74% of total billed charges,262.7,74,,,percent of total billed charges,74% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,237.85,67,,,percent of total billed charges,67% of total billed charges,237.85,67,,,percent of total billed charges,67% of total billed charges,252.05,71,,,percent of total billed charges,71% of total billed charges,269.8,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,117.01,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,319.5,90,,,percent of total billed charges,90% of total billed charges,319.5,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,314.53,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,284,80,,,percent of total billed charges,80% of total billed charges,284,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,323.05,91,,,percent of total billed charges,91% of total billed charges,115.87,32.64,,,percent of total billed charges,32.64% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,119.28,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.6,32,,,percent of total billed charges,32% of total billed charges,113.6,32,,,percent of total billed charges,32% of total billed charges,326.6,92,,,percent of total billed charges,92% of total billed charges,34.98,326.6,
ABD 3V OR >,4000394,CDM,320,RC,74021,HCPCS,Outpatient,,,507,430.95,,411.68,81.2,,,percent of total billed charges,81.2% of total billed charges,165.48,32.64,,,percent of total billed charges,32.64% of total billed charges,375.18,74,,,percent of total billed charges,74% of total billed charges,375.18,74,,,percent of total billed charges,74% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,162.24,32,,,percent of total billed charges,32% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,339.69,67,,,percent of total billed charges,67% of total billed charges,339.69,67,,,percent of total billed charges,67% of total billed charges,359.97,71,,,percent of total billed charges,71% of total billed charges,385.32,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,167.11,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,456.3,90,,,percent of total billed charges,90% of total billed charges,456.3,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,449.2,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,162.24,32,,,percent of total billed charges,32% of total billed charges,405.6,80,,,percent of total billed charges,80% of total billed charges,405.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,461.37,91,,,percent of total billed charges,91% of total billed charges,165.48,32.64,,,percent of total billed charges,32.64% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,170.35,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,162.24,32,,,percent of total billed charges,32% of total billed charges,162.24,32,,,percent of total billed charges,32% of total billed charges,466.44,92,,,percent of total billed charges,92% of total billed charges,34.98,466.44,
AAS,4000101,CDM,320,RC,74022,HCPCS,Outpatient,,,401,340.85,,325.61,81.2,,,percent of total billed charges,81.2% of total billed charges,130.89,32.64,,,percent of total billed charges,32.64% of total billed charges,296.74,74,,,percent of total billed charges,74% of total billed charges,296.74,74,,,percent of total billed charges,74% of total billed charges,128.32,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.32,32,,,percent of total billed charges,32% of total billed charges,284.71,71,,,percent of total billed charges,71% of total billed charges,284.71,71,,,percent of total billed charges,71% of total billed charges,268.67,67,,,percent of total billed charges,67% of total billed charges,268.67,67,,,percent of total billed charges,67% of total billed charges,284.71,71,,,percent of total billed charges,71% of total billed charges,304.76,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,132.17,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,360.9,90,,,percent of total billed charges,90% of total billed charges,360.9,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,355.29,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.32,32,,,percent of total billed charges,32% of total billed charges,320.8,80,,,percent of total billed charges,80% of total billed charges,320.8,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,364.91,91,,,percent of total billed charges,91% of total billed charges,130.89,32.64,,,percent of total billed charges,32.64% of total billed charges,128.32,32,,,percent of total billed charges,32% of total billed charges,134.74,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,128.32,32,,,percent of total billed charges,32% of total billed charges,128.32,32,,,percent of total billed charges,32% of total billed charges,368.92,92,,,percent of total billed charges,92% of total billed charges,34.98,368.92,
CT ABD/PEL W,4000289,CDM,350,RC,74177,HCPCS,Outpatient,,,3350,2847.5,,2720.2,81.2,,,percent of total billed charges,81.2% of total billed charges,1093.44,32.64,,,percent of total billed charges,32.64% of total billed charges,1027,100,,,Case rate,Pays based on per visit,1027,100,,,Case rate,Pays based on per visit,1072,32,,,percent of total billed charges,32% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,1072,32,,,percent of total billed charges,32% of total billed charges,976,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,925,100,,,Case rate,pays based on per visit,976,100,,,Case rate,pays based on per visit,2546,100,,,Case rate,pays based on per visit,249.83,103,,,Fee Schedule,pays based on EAPG rates,1104.16,32.96,,,percent of total billed charges,32.96% of total billed charges,254.68,105,,,Fee Schedule,pays based on EAPG rates,3015,90,,,percent of total billed charges,90% of total billed charges,3015,90,,,percent of total billed charges,90% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,2968.1,88.6,,,percent of total billed charges,88.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,1072,32,,,percent of total billed charges,32% of total billed charges,2680,80,,,percent of total billed charges,80% of total billed charges,2680,80,,,percent of total billed charges,80% of total billed charges,242.56,100,,,Fee Schedule,pays based on EAPG rates,3048.5,91,,,percent of total billed charges,91% of total billed charges,1093.44,32.64,,,percent of total billed charges,32.64% of total billed charges,1072,32,,,percent of total billed charges,32% of total billed charges,1125.6,33.6,,,percent of total billed charges,33.6% of total billed charges,249.83,103,,,Fee Schedule,pays based on EAPG rates,1072,32,,,percent of total billed charges,32% of total billed charges,1072,32,,,percent of total billed charges,32% of total billed charges,3082,92,,,percent of total billed charges,92% of total billed charges,242.56,3082,
ESOPHAGRAM,4000089,CDM,320,RC,74220,HCPCS,Outpatient,,,344,292.4,,279.33,81.2,,,percent of total billed charges,81.2% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,261.44,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,113.38,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,304.78,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,313.04,91,,,percent of total billed charges,91% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,115.58,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,316.48,92,,,percent of total billed charges,92% of total billed charges,34.98,316.48,
MODIFIED VIDEO SWALLOW,4000295,CDM,320,RC,74230,HCPCS,Outpatient,,,344,292.4,,279.33,81.2,,,percent of total billed charges,81.2% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,261.44,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,113.38,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,304.78,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,313.04,91,,,percent of total billed charges,91% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,115.58,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,316.48,92,,,percent of total billed charges,92% of total billed charges,87.85,316.48,
UGI SINGLE CONTRAST,4000229,CDM,320,RC,74240,HCPCS,Outpatient,,,449,381.65,,364.59,81.2,,,percent of total billed charges,81.2% of total billed charges,146.55,32.64,,,percent of total billed charges,32.64% of total billed charges,332.26,74,,,percent of total billed charges,74% of total billed charges,332.26,74,,,percent of total billed charges,74% of total billed charges,143.68,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.68,32,,,percent of total billed charges,32% of total billed charges,318.79,71,,,percent of total billed charges,71% of total billed charges,318.79,71,,,percent of total billed charges,71% of total billed charges,300.83,67,,,percent of total billed charges,67% of total billed charges,300.83,67,,,percent of total billed charges,67% of total billed charges,318.79,71,,,percent of total billed charges,71% of total billed charges,341.24,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,147.99,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,404.1,90,,,percent of total billed charges,90% of total billed charges,404.1,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,397.81,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.68,32,,,percent of total billed charges,32% of total billed charges,359.2,80,,,percent of total billed charges,80% of total billed charges,359.2,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,408.59,91,,,percent of total billed charges,91% of total billed charges,146.55,32.64,,,percent of total billed charges,32.64% of total billed charges,143.68,32,,,percent of total billed charges,32% of total billed charges,150.86,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.68,32,,,percent of total billed charges,32% of total billed charges,143.68,32,,,percent of total billed charges,32% of total billed charges,413.08,92,,,percent of total billed charges,92% of total billed charges,87.85,413.08,
UGI DOUBLE CONTRAST,4000098,CDM,320,RC,74246,HCPCS,Outpatient,,,447,379.95,,362.96,81.2,,,percent of total billed charges,81.2% of total billed charges,145.9,32.64,,,percent of total billed charges,32.64% of total billed charges,330.78,74,,,percent of total billed charges,74% of total billed charges,330.78,74,,,percent of total billed charges,74% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,299.49,67,,,percent of total billed charges,67% of total billed charges,299.49,67,,,percent of total billed charges,67% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,339.72,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,147.33,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,402.3,90,,,percent of total billed charges,90% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,396.04,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,406.77,91,,,percent of total billed charges,91% of total billed charges,145.9,32.64,,,percent of total billed charges,32.64% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,150.19,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,411.24,92,,,percent of total billed charges,92% of total billed charges,87.85,411.24,
UGI W/ SBFT (DOUBLE CONTRAST),4000099,CDM,320,RC,74246,HCPCS,Outpatient,,,447,379.95,,362.96,81.2,,,percent of total billed charges,81.2% of total billed charges,145.9,32.64,,,percent of total billed charges,32.64% of total billed charges,330.78,74,,,percent of total billed charges,74% of total billed charges,330.78,74,,,percent of total billed charges,74% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,299.49,67,,,percent of total billed charges,67% of total billed charges,299.49,67,,,percent of total billed charges,67% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,339.72,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,147.33,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,402.3,90,,,percent of total billed charges,90% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,396.04,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,406.77,91,,,percent of total billed charges,91% of total billed charges,145.9,32.64,,,percent of total billed charges,32.64% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,150.19,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,411.24,92,,,percent of total billed charges,92% of total billed charges,87.85,411.24,
UGI W/ ESOPHAGRAM (DOUBLE CONTRAST),4000402,CDM,320,RC,74246,HCPCS,Outpatient,,,788,669.8,,639.86,81.2,,,percent of total billed charges,81.2% of total billed charges,257.2,32.64,,,percent of total billed charges,32.64% of total billed charges,583.12,74,,,percent of total billed charges,74% of total billed charges,583.12,74,,,percent of total billed charges,74% of total billed charges,252.16,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,252.16,32,,,percent of total billed charges,32% of total billed charges,559.48,71,,,percent of total billed charges,71% of total billed charges,559.48,71,,,percent of total billed charges,71% of total billed charges,527.96,67,,,percent of total billed charges,67% of total billed charges,527.96,67,,,percent of total billed charges,67% of total billed charges,559.48,71,,,percent of total billed charges,71% of total billed charges,598.88,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,259.72,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,709.2,90,,,percent of total billed charges,90% of total billed charges,709.2,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,698.17,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,252.16,32,,,percent of total billed charges,32% of total billed charges,630.4,80,,,percent of total billed charges,80% of total billed charges,630.4,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,717.08,91,,,percent of total billed charges,91% of total billed charges,257.2,32.64,,,percent of total billed charges,32.64% of total billed charges,252.16,32,,,percent of total billed charges,32% of total billed charges,264.77,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,252.16,32,,,percent of total billed charges,32% of total billed charges,252.16,32,,,percent of total billed charges,32% of total billed charges,724.96,92,,,percent of total billed charges,92% of total billed charges,87.85,724.96,
SMALL INTESTINE FOLLOW-THRU STUDY,4000398,CDM,320,RC,74248,HCPCS,Outpatient,,,342,290.7,,277.7,81.2,,,percent of total billed charges,81.2% of total billed charges,111.63,32.64,,,percent of total billed charges,32.64% of total billed charges,253.08,74,,,percent of total billed charges,74% of total billed charges,253.08,74,,,percent of total billed charges,74% of total billed charges,109.44,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,109.44,32,,,percent of total billed charges,32% of total billed charges,242.82,71,,,percent of total billed charges,71% of total billed charges,242.82,71,,,percent of total billed charges,71% of total billed charges,229.14,67,,,percent of total billed charges,67% of total billed charges,229.14,67,,,percent of total billed charges,67% of total billed charges,242.82,71,,,percent of total billed charges,71% of total billed charges,259.92,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,112.72,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,307.8,90,,,percent of total billed charges,90% of total billed charges,307.8,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,303.01,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,109.44,32,,,percent of total billed charges,32% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,273.6,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,311.22,91,,,percent of total billed charges,91% of total billed charges,111.63,32.64,,,percent of total billed charges,32.64% of total billed charges,109.44,32,,,percent of total billed charges,32% of total billed charges,114.91,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,109.44,32,,,percent of total billed charges,32% of total billed charges,109.44,32,,,percent of total billed charges,32% of total billed charges,314.64,92,,,percent of total billed charges,92% of total billed charges,87.85,314.64,
SBFT (W/O UGI),4000097,CDM,320,RC,74250,HCPCS,Outpatient,,,687,583.95,,557.84,81.2,,,percent of total billed charges,81.2% of total billed charges,224.24,32.64,,,percent of total billed charges,32.64% of total billed charges,508.38,74,,,percent of total billed charges,74% of total billed charges,508.38,74,,,percent of total billed charges,74% of total billed charges,219.84,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,219.84,32,,,percent of total billed charges,32% of total billed charges,487.77,71,,,percent of total billed charges,71% of total billed charges,487.77,71,,,percent of total billed charges,71% of total billed charges,460.29,67,,,percent of total billed charges,67% of total billed charges,460.29,67,,,percent of total billed charges,67% of total billed charges,487.77,71,,,percent of total billed charges,71% of total billed charges,522.12,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,226.44,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,618.3,90,,,percent of total billed charges,90% of total billed charges,618.3,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,608.68,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,219.84,32,,,percent of total billed charges,32% of total billed charges,549.6,80,,,percent of total billed charges,80% of total billed charges,549.6,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,625.17,91,,,percent of total billed charges,91% of total billed charges,224.24,32.64,,,percent of total billed charges,32.64% of total billed charges,219.84,32,,,percent of total billed charges,32% of total billed charges,230.83,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,219.84,32,,,percent of total billed charges,32% of total billed charges,219.84,32,,,percent of total billed charges,32% of total billed charges,632.04,92,,,percent of total billed charges,92% of total billed charges,87.85,632.04,
BE,4000086,CDM,320,RC,74270,HCPCS,Outpatient,,,551,468.35,,447.41,81.2,,,percent of total billed charges,81.2% of total billed charges,179.85,32.64,,,percent of total billed charges,32.64% of total billed charges,407.74,74,,,percent of total billed charges,74% of total billed charges,407.74,74,,,percent of total billed charges,74% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,369.17,67,,,percent of total billed charges,67% of total billed charges,369.17,67,,,percent of total billed charges,67% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,418.76,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,181.61,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,488.19,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,501.41,91,,,percent of total billed charges,91% of total billed charges,179.85,32.64,,,percent of total billed charges,32.64% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,185.14,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,506.92,92,,,percent of total billed charges,92% of total billed charges,87.85,506.92,
BE W/ GASTROGRAFIN,4000088,CDM,320,RC,74270,HCPCS,Outpatient,,,551,468.35,,447.41,81.2,,,percent of total billed charges,81.2% of total billed charges,179.85,32.64,,,percent of total billed charges,32.64% of total billed charges,407.74,74,,,percent of total billed charges,74% of total billed charges,407.74,74,,,percent of total billed charges,74% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,369.17,67,,,percent of total billed charges,67% of total billed charges,369.17,67,,,percent of total billed charges,67% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,418.76,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,181.61,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,488.19,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,501.41,91,,,percent of total billed charges,91% of total billed charges,179.85,32.64,,,percent of total billed charges,32.64% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,185.14,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,506.92,92,,,percent of total billed charges,92% of total billed charges,87.85,506.92,
BE W/ AIR,4000087,CDM,320,RC,74280,HCPCS,Outpatient,,,551,468.35,,447.41,81.2,,,percent of total billed charges,81.2% of total billed charges,179.85,32.64,,,percent of total billed charges,32.64% of total billed charges,407.74,74,,,percent of total billed charges,74% of total billed charges,407.74,74,,,percent of total billed charges,74% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,369.17,67,,,percent of total billed charges,67% of total billed charges,369.17,67,,,percent of total billed charges,67% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,418.76,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,181.61,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,488.19,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,501.41,91,,,percent of total billed charges,91% of total billed charges,179.85,32.64,,,percent of total billed charges,32.64% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,185.14,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,506.92,92,,,percent of total billed charges,92% of total billed charges,87.85,506.92,
CHOL/T TUBE INTRAOP,4000314,CDM,320,RC,74300,HCPCS,Outpatient,,,179,152.15,,145.35,81.2,,,percent of total billed charges,81.2% of total billed charges,58.43,32.64,,,percent of total billed charges,32.64% of total billed charges,132.46,74,,,percent of total billed charges,74% of total billed charges,132.46,74,,,percent of total billed charges,74% of total billed charges,57.28,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,57.28,32,,,percent of total billed charges,32% of total billed charges,127.09,71,,,percent of total billed charges,71% of total billed charges,127.09,71,,,percent of total billed charges,71% of total billed charges,119.93,67,,,percent of total billed charges,67% of total billed charges,119.93,67,,,percent of total billed charges,67% of total billed charges,127.09,71,,,percent of total billed charges,71% of total billed charges,136.04,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,59,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,161.1,90,,,percent of total billed charges,90% of total billed charges,161.1,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,158.59,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,57.28,32,,,percent of total billed charges,32% of total billed charges,143.2,80,,,percent of total billed charges,80% of total billed charges,143.2,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,162.89,91,,,percent of total billed charges,91% of total billed charges,58.43,32.64,,,percent of total billed charges,32.64% of total billed charges,57.28,32,,,percent of total billed charges,32% of total billed charges,60.14,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,57.28,32,,,percent of total billed charges,32% of total billed charges,57.28,32,,,percent of total billed charges,32% of total billed charges,164.68,92,,,percent of total billed charges,92% of total billed charges,57.28,164.68,
CHOL/T TUBE INTRAOP ADDITIONAL,4000213,CDM,320,RC,74301,HCPCS,Outpatient,,,179,152.15,,145.35,81.2,,,percent of total billed charges,81.2% of total billed charges,58.43,32.64,,,percent of total billed charges,32.64% of total billed charges,132.46,74,,,percent of total billed charges,74% of total billed charges,132.46,74,,,percent of total billed charges,74% of total billed charges,57.28,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,57.28,32,,,percent of total billed charges,32% of total billed charges,127.09,71,,,percent of total billed charges,71% of total billed charges,127.09,71,,,percent of total billed charges,71% of total billed charges,119.93,67,,,percent of total billed charges,67% of total billed charges,119.93,67,,,percent of total billed charges,67% of total billed charges,127.09,71,,,percent of total billed charges,71% of total billed charges,136.04,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,59,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,161.1,90,,,percent of total billed charges,90% of total billed charges,161.1,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,158.59,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,57.28,32,,,percent of total billed charges,32% of total billed charges,143.2,80,,,percent of total billed charges,80% of total billed charges,143.2,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,162.89,91,,,percent of total billed charges,91% of total billed charges,58.43,32.64,,,percent of total billed charges,32.64% of total billed charges,57.28,32,,,percent of total billed charges,32% of total billed charges,60.14,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,57.28,32,,,percent of total billed charges,32% of total billed charges,57.28,32,,,percent of total billed charges,32% of total billed charges,164.68,92,,,percent of total billed charges,92% of total billed charges,57.28,164.68,
ERCP,4000118,CDM,320,RC,74330,HCPCS,Outpatient,,,676,574.6,,548.91,81.2,,,percent of total billed charges,81.2% of total billed charges,220.65,32.64,,,percent of total billed charges,32.64% of total billed charges,500.24,74,,,percent of total billed charges,74% of total billed charges,500.24,74,,,percent of total billed charges,74% of total billed charges,216.32,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,216.32,32,,,percent of total billed charges,32% of total billed charges,479.96,71,,,percent of total billed charges,71% of total billed charges,479.96,71,,,percent of total billed charges,71% of total billed charges,452.92,67,,,percent of total billed charges,67% of total billed charges,452.92,67,,,percent of total billed charges,67% of total billed charges,479.96,71,,,percent of total billed charges,71% of total billed charges,513.76,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,222.81,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,608.4,90,,,percent of total billed charges,90% of total billed charges,608.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,598.94,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,216.32,32,,,percent of total billed charges,32% of total billed charges,540.8,80,,,percent of total billed charges,80% of total billed charges,540.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,615.16,91,,,percent of total billed charges,91% of total billed charges,220.65,32.64,,,percent of total billed charges,32.64% of total billed charges,216.32,32,,,percent of total billed charges,32% of total billed charges,227.14,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,216.32,32,,,percent of total billed charges,32% of total billed charges,216.32,32,,,percent of total billed charges,32% of total billed charges,621.92,92,,,percent of total billed charges,92% of total billed charges,69.41,621.92,
IVP,4000112,CDM,320,RC,74400,HCPCS,Outpatient,,,551,468.35,,447.41,81.2,,,percent of total billed charges,81.2% of total billed charges,179.85,32.64,,,percent of total billed charges,32.64% of total billed charges,407.74,74,,,percent of total billed charges,74% of total billed charges,407.74,74,,,percent of total billed charges,74% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,369.17,67,,,percent of total billed charges,67% of total billed charges,369.17,67,,,percent of total billed charges,67% of total billed charges,391.21,71,,,percent of total billed charges,71% of total billed charges,418.76,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,181.61,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,488.19,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,440.8,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,501.41,91,,,percent of total billed charges,91% of total billed charges,179.85,32.64,,,percent of total billed charges,32.64% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,185.14,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,176.32,32,,,percent of total billed charges,32% of total billed charges,176.32,32,,,percent of total billed charges,32% of total billed charges,506.92,92,,,percent of total billed charges,92% of total billed charges,87.85,506.92,
RETRO.PYELOGRAM W/ OR W/O KUB,4000094,CDM,320,RC,74420,HCPCS,Outpatient,,,381,323.85,,309.37,81.2,,,percent of total billed charges,81.2% of total billed charges,124.36,32.64,,,percent of total billed charges,32.64% of total billed charges,281.94,74,,,percent of total billed charges,74% of total billed charges,281.94,74,,,percent of total billed charges,74% of total billed charges,121.92,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,121.92,32,,,percent of total billed charges,32% of total billed charges,270.51,71,,,percent of total billed charges,71% of total billed charges,270.51,71,,,percent of total billed charges,71% of total billed charges,255.27,67,,,percent of total billed charges,67% of total billed charges,255.27,67,,,percent of total billed charges,67% of total billed charges,270.51,71,,,percent of total billed charges,71% of total billed charges,289.56,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,125.58,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,342.9,90,,,percent of total billed charges,90% of total billed charges,342.9,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,337.57,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,121.92,32,,,percent of total billed charges,32% of total billed charges,304.8,80,,,percent of total billed charges,80% of total billed charges,304.8,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,346.71,91,,,percent of total billed charges,91% of total billed charges,124.36,32.64,,,percent of total billed charges,32.64% of total billed charges,121.92,32,,,percent of total billed charges,32% of total billed charges,128.02,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,121.92,32,,,percent of total billed charges,32% of total billed charges,121.92,32,,,percent of total billed charges,32% of total billed charges,350.52,92,,,percent of total billed charges,92% of total billed charges,87.85,350.52,
CYSTOGRAM MIN 3V,4000117,CDM,320,RC,74430,HCPCS,Outpatient,,,381,323.85,,309.37,81.2,,,percent of total billed charges,81.2% of total billed charges,124.36,32.64,,,percent of total billed charges,32.64% of total billed charges,281.94,74,,,percent of total billed charges,74% of total billed charges,281.94,74,,,percent of total billed charges,74% of total billed charges,121.92,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,121.92,32,,,percent of total billed charges,32% of total billed charges,270.51,71,,,percent of total billed charges,71% of total billed charges,270.51,71,,,percent of total billed charges,71% of total billed charges,255.27,67,,,percent of total billed charges,67% of total billed charges,255.27,67,,,percent of total billed charges,67% of total billed charges,270.51,71,,,percent of total billed charges,71% of total billed charges,289.56,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,125.58,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,342.9,90,,,percent of total billed charges,90% of total billed charges,342.9,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,337.57,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,121.92,32,,,percent of total billed charges,32% of total billed charges,304.8,80,,,percent of total billed charges,80% of total billed charges,304.8,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,346.71,91,,,percent of total billed charges,91% of total billed charges,124.36,32.64,,,percent of total billed charges,32.64% of total billed charges,121.92,32,,,percent of total billed charges,32% of total billed charges,128.02,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,121.92,32,,,percent of total billed charges,32% of total billed charges,121.92,32,,,percent of total billed charges,32% of total billed charges,350.52,92,,,percent of total billed charges,92% of total billed charges,87.85,350.52,
VCU,4000091,CDM,320,RC,74455,HCPCS,Outpatient,,,394,334.9,,319.93,81.2,,,percent of total billed charges,81.2% of total billed charges,128.6,32.64,,,percent of total billed charges,32.64% of total billed charges,291.56,74,,,percent of total billed charges,74% of total billed charges,291.56,74,,,percent of total billed charges,74% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,263.98,67,,,percent of total billed charges,67% of total billed charges,263.98,67,,,percent of total billed charges,67% of total billed charges,279.74,71,,,percent of total billed charges,71% of total billed charges,299.44,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,129.86,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,354.6,90,,,percent of total billed charges,90% of total billed charges,354.6,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,349.08,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,315.2,80,,,percent of total billed charges,80% of total billed charges,315.2,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,358.54,91,,,percent of total billed charges,91% of total billed charges,128.6,32.64,,,percent of total billed charges,32.64% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,132.38,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,126.08,32,,,percent of total billed charges,32% of total billed charges,126.08,32,,,percent of total billed charges,32% of total billed charges,362.48,92,,,percent of total billed charges,92% of total billed charges,87.85,362.48,
SALPINGOGRAM,4000095,CDM,320,RC,74740,HCPCS,Outpatient,,,447,379.95,,362.96,81.2,,,percent of total billed charges,81.2% of total billed charges,145.9,32.64,,,percent of total billed charges,32.64% of total billed charges,330.78,74,,,percent of total billed charges,74% of total billed charges,330.78,74,,,percent of total billed charges,74% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,299.49,67,,,percent of total billed charges,67% of total billed charges,299.49,67,,,percent of total billed charges,67% of total billed charges,317.37,71,,,percent of total billed charges,71% of total billed charges,339.72,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,147.33,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,402.3,90,,,percent of total billed charges,90% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,396.04,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,357.6,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,406.77,91,,,percent of total billed charges,91% of total billed charges,145.9,32.64,,,percent of total billed charges,32.64% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,150.19,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,143.04,32,,,percent of total billed charges,32% of total billed charges,143.04,32,,,percent of total billed charges,32% of total billed charges,411.24,92,,,percent of total billed charges,92% of total billed charges,87.85,411.24,
VAGINOGRAM,4000110,CDM,320,RC,74775,HCPCS,Outpatient,,,364,309.4,,295.57,81.2,,,percent of total billed charges,81.2% of total billed charges,118.81,32.64,,,percent of total billed charges,32.64% of total billed charges,269.36,74,,,percent of total billed charges,74% of total billed charges,269.36,74,,,percent of total billed charges,74% of total billed charges,116.48,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,116.48,32,,,percent of total billed charges,32% of total billed charges,258.44,71,,,percent of total billed charges,71% of total billed charges,258.44,71,,,percent of total billed charges,71% of total billed charges,243.88,67,,,percent of total billed charges,67% of total billed charges,243.88,67,,,percent of total billed charges,67% of total billed charges,258.44,71,,,percent of total billed charges,71% of total billed charges,276.64,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,119.97,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,327.6,90,,,percent of total billed charges,90% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,322.5,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,116.48,32,,,percent of total billed charges,32% of total billed charges,291.2,80,,,percent of total billed charges,80% of total billed charges,291.2,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,331.24,91,,,percent of total billed charges,91% of total billed charges,118.81,32.64,,,percent of total billed charges,32.64% of total billed charges,116.48,32,,,percent of total billed charges,32% of total billed charges,122.3,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,116.48,32,,,percent of total billed charges,32% of total billed charges,116.48,32,,,percent of total billed charges,32% of total billed charges,334.88,92,,,percent of total billed charges,92% of total billed charges,87.85,334.88,
PERC DRAIN ABSC,4000170,CDM,320,RC,75989,HCPCS,Outpatient,,,787,668.95,,639.04,81.2,,,percent of total billed charges,81.2% of total billed charges,256.88,32.64,,,percent of total billed charges,32.64% of total billed charges,582.38,74,,,percent of total billed charges,74% of total billed charges,582.38,74,,,percent of total billed charges,74% of total billed charges,251.84,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,251.84,32,,,percent of total billed charges,32% of total billed charges,558.77,71,,,percent of total billed charges,71% of total billed charges,558.77,71,,,percent of total billed charges,71% of total billed charges,527.29,67,,,percent of total billed charges,67% of total billed charges,527.29,67,,,percent of total billed charges,67% of total billed charges,558.77,71,,,percent of total billed charges,71% of total billed charges,598.12,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,259.4,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,708.3,90,,,percent of total billed charges,90% of total billed charges,708.3,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,697.28,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,251.84,32,,,percent of total billed charges,32% of total billed charges,629.6,80,,,percent of total billed charges,80% of total billed charges,629.6,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,716.17,91,,,percent of total billed charges,91% of total billed charges,256.88,32.64,,,percent of total billed charges,32.64% of total billed charges,251.84,32,,,percent of total billed charges,32% of total billed charges,264.43,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,251.84,32,,,percent of total billed charges,32% of total billed charges,251.84,32,,,percent of total billed charges,32% of total billed charges,724.04,92,,,percent of total billed charges,92% of total billed charges,69.41,724.04,
FLUORO W/ RAD,4000105,CDM,320,RC,76000,HCPCS,Outpatient,,,584,496.4,,474.21,81.2,,,percent of total billed charges,81.2% of total billed charges,190.62,32.64,,,percent of total billed charges,32.64% of total billed charges,432.16,74,,,percent of total billed charges,74% of total billed charges,432.16,74,,,percent of total billed charges,74% of total billed charges,186.88,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,186.88,32,,,percent of total billed charges,32% of total billed charges,414.64,71,,,percent of total billed charges,71% of total billed charges,414.64,71,,,percent of total billed charges,71% of total billed charges,391.28,67,,,percent of total billed charges,67% of total billed charges,391.28,67,,,percent of total billed charges,67% of total billed charges,414.64,71,,,percent of total billed charges,71% of total billed charges,443.84,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,192.49,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,525.6,90,,,percent of total billed charges,90% of total billed charges,525.6,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,517.42,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,186.88,32,,,percent of total billed charges,32% of total billed charges,467.2,80,,,percent of total billed charges,80% of total billed charges,467.2,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,531.44,91,,,percent of total billed charges,91% of total billed charges,190.62,32.64,,,percent of total billed charges,32.64% of total billed charges,186.88,32,,,percent of total billed charges,32% of total billed charges,196.22,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,186.88,32,,,percent of total billed charges,32% of total billed charges,186.88,32,,,percent of total billed charges,32% of total billed charges,537.28,92,,,percent of total billed charges,92% of total billed charges,87.85,537.28,
FLUORO W/O RAD,4000092,CDM,320,RC,76000,HCPCS,Outpatient,,,584,496.4,,474.21,81.2,,,percent of total billed charges,81.2% of total billed charges,190.62,32.64,,,percent of total billed charges,32.64% of total billed charges,432.16,74,,,percent of total billed charges,74% of total billed charges,432.16,74,,,percent of total billed charges,74% of total billed charges,186.88,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,186.88,32,,,percent of total billed charges,32% of total billed charges,414.64,71,,,percent of total billed charges,71% of total billed charges,414.64,71,,,percent of total billed charges,71% of total billed charges,391.28,67,,,percent of total billed charges,67% of total billed charges,391.28,67,,,percent of total billed charges,67% of total billed charges,414.64,71,,,percent of total billed charges,71% of total billed charges,443.84,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,192.49,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,525.6,90,,,percent of total billed charges,90% of total billed charges,525.6,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,517.42,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,186.88,32,,,percent of total billed charges,32% of total billed charges,467.2,80,,,percent of total billed charges,80% of total billed charges,467.2,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,531.44,91,,,percent of total billed charges,91% of total billed charges,190.62,32.64,,,percent of total billed charges,32.64% of total billed charges,186.88,32,,,percent of total billed charges,32% of total billed charges,196.22,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,186.88,32,,,percent of total billed charges,32% of total billed charges,186.88,32,,,percent of total billed charges,32% of total billed charges,537.28,92,,,percent of total billed charges,92% of total billed charges,87.85,537.28,
FLUORO FOR CENTRAL VENOUS ACCESS DEVICE,4000298,CDM,320,RC,77001,HCPCS,Outpatient,,,584,496.4,,474.21,81.2,,,percent of total billed charges,81.2% of total billed charges,190.62,32.64,,,percent of total billed charges,32.64% of total billed charges,432.16,74,,,percent of total billed charges,74% of total billed charges,432.16,74,,,percent of total billed charges,74% of total billed charges,186.88,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,186.88,32,,,percent of total billed charges,32% of total billed charges,414.64,71,,,percent of total billed charges,71% of total billed charges,414.64,71,,,percent of total billed charges,71% of total billed charges,391.28,67,,,percent of total billed charges,67% of total billed charges,391.28,67,,,percent of total billed charges,67% of total billed charges,414.64,71,,,percent of total billed charges,71% of total billed charges,443.84,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,192.49,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,525.6,90,,,percent of total billed charges,90% of total billed charges,525.6,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,517.42,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,186.88,32,,,percent of total billed charges,32% of total billed charges,467.2,80,,,percent of total billed charges,80% of total billed charges,467.2,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,531.44,91,,,percent of total billed charges,91% of total billed charges,190.62,32.64,,,percent of total billed charges,32.64% of total billed charges,186.88,32,,,percent of total billed charges,32% of total billed charges,196.22,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,186.88,32,,,percent of total billed charges,32% of total billed charges,186.88,32,,,percent of total billed charges,32% of total billed charges,537.28,92,,,percent of total billed charges,92% of total billed charges,69.41,537.28,
FLUORO GUID INJ,4000277,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
INJECTION HIP BILAT,4000339,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
INJECTION HIP LT,4000338,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
INJECTION HIP RT,4000337,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
INJECTION KNEE BILAT,4000342,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
INJECTION KNEE LT,4000341,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
INJECTION KNEE RT,4000340,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
INJECTION SHOULDER BILAT,4000336,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
INJECTION SHOULDER LT,4000335,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
INJECTION SHOULDER RT,4000334,CDM,320,RC,77002,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,69.41,548.32,
FLUORO FOR SPINAL INJECTION,4000317,CDM,320,RC,77003,HCPCS,Outpatient,,,90,76.5,,73.08,81.2,,,percent of total billed charges,81.2% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,66.6,74,,,percent of total billed charges,74% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,60.3,67,,,percent of total billed charges,67% of total billed charges,63.9,71,,,percent of total billed charges,71% of total billed charges,68.4,76,,,percent of total billed charges,76% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,29.66,32.96,,,percent of total billed charges,32.96% of total billed charges,72.88,105,,,Fee Schedule,pays based on EAPG rates,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,79.74,88.6,,,percent of total billed charges,88.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,72,80,,,percent of total billed charges,80% of total billed charges,69.41,100,,,Fee Schedule,pays based on EAPG rates,81.9,91,,,percent of total billed charges,91% of total billed charges,29.38,32.64,,,percent of total billed charges,32.64% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,30.24,33.6,,,percent of total billed charges,33.6% of total billed charges,71.5,103,,,Fee Schedule,pays based on EAPG rates,28.8,32,,,percent of total billed charges,32% of total billed charges,28.8,32,,,percent of total billed charges,32% of total billed charges,82.8,92,,,percent of total billed charges,92% of total billed charges,28.8,82.8,
BONE AGE STUDIES,4000278,CDM,320,RC,77072,HCPCS,Outpatient,,,769,653.65,,624.43,81.2,,,percent of total billed charges,81.2% of total billed charges,251,32.64,,,percent of total billed charges,32.64% of total billed charges,569.06,74,,,percent of total billed charges,74% of total billed charges,569.06,74,,,percent of total billed charges,74% of total billed charges,246.08,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,246.08,32,,,percent of total billed charges,32% of total billed charges,545.99,71,,,percent of total billed charges,71% of total billed charges,545.99,71,,,percent of total billed charges,71% of total billed charges,515.23,67,,,percent of total billed charges,67% of total billed charges,515.23,67,,,percent of total billed charges,67% of total billed charges,545.99,71,,,percent of total billed charges,71% of total billed charges,584.44,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,253.46,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,692.1,90,,,percent of total billed charges,90% of total billed charges,692.1,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,681.33,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,246.08,32,,,percent of total billed charges,32% of total billed charges,615.2,80,,,percent of total billed charges,80% of total billed charges,615.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,699.79,91,,,percent of total billed charges,91% of total billed charges,251,32.64,,,percent of total billed charges,32.64% of total billed charges,246.08,32,,,percent of total billed charges,32% of total billed charges,258.38,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,246.08,32,,,percent of total billed charges,32% of total billed charges,246.08,32,,,percent of total billed charges,32% of total billed charges,707.48,92,,,percent of total billed charges,92% of total billed charges,34.98,707.48,
BONE LENGTH,4000109,CDM,320,RC,77073,HCPCS,Outpatient,,,334,283.9,,271.21,81.2,,,percent of total billed charges,81.2% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,247.16,74,,,percent of total billed charges,74% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,223.78,67,,,percent of total billed charges,67% of total billed charges,237.14,71,,,percent of total billed charges,71% of total billed charges,253.84,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,110.09,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,295.92,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,267.2,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,303.94,91,,,percent of total billed charges,91% of total billed charges,109.02,32.64,,,percent of total billed charges,32.64% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,112.22,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,106.88,32,,,percent of total billed charges,32% of total billed charges,106.88,32,,,percent of total billed charges,32% of total billed charges,307.28,92,,,percent of total billed charges,92% of total billed charges,34.98,307.28,
BONE SURVEY COMPLETE,4000066,CDM,320,RC,77075,HCPCS,Outpatient,,,745,633.25,,604.94,81.2,,,percent of total billed charges,81.2% of total billed charges,243.17,32.64,,,percent of total billed charges,32.64% of total billed charges,551.3,74,,,percent of total billed charges,74% of total billed charges,551.3,74,,,percent of total billed charges,74% of total billed charges,238.4,32,,,percent of total billed charges,32% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,238.4,32,,,percent of total billed charges,32% of total billed charges,528.95,71,,,percent of total billed charges,71% of total billed charges,528.95,71,,,percent of total billed charges,71% of total billed charges,499.15,67,,,percent of total billed charges,67% of total billed charges,499.15,67,,,percent of total billed charges,67% of total billed charges,528.95,71,,,percent of total billed charges,71% of total billed charges,566.2,76,,,percent of total billed charges,76% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,245.55,32.96,,,percent of total billed charges,32.96% of total billed charges,92.25,105,,,Fee Schedule,pays based on EAPG rates,670.5,90,,,percent of total billed charges,90% of total billed charges,670.5,90,,,percent of total billed charges,90% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,660.07,88.6,,,percent of total billed charges,88.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,238.4,32,,,percent of total billed charges,32% of total billed charges,596,80,,,percent of total billed charges,80% of total billed charges,596,80,,,percent of total billed charges,80% of total billed charges,87.85,100,,,Fee Schedule,pays based on EAPG rates,677.95,91,,,percent of total billed charges,91% of total billed charges,243.17,32.64,,,percent of total billed charges,32.64% of total billed charges,238.4,32,,,percent of total billed charges,32% of total billed charges,250.32,33.6,,,percent of total billed charges,33.6% of total billed charges,90.49,103,,,Fee Schedule,pays based on EAPG rates,238.4,32,,,percent of total billed charges,32% of total billed charges,238.4,32,,,percent of total billed charges,32% of total billed charges,685.4,92,,,percent of total billed charges,92% of total billed charges,87.85,685.4,
BONE SURVEY INFANT,4000403,CDM,320,RC,77076,HCPCS,Outpatient,,,352,299.2,,285.82,81.2,,,percent of total billed charges,81.2% of total billed charges,114.89,32.64,,,percent of total billed charges,32.64% of total billed charges,260.48,74,,,percent of total billed charges,74% of total billed charges,260.48,74,,,percent of total billed charges,74% of total billed charges,112.64,32,,,percent of total billed charges,32% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,112.64,32,,,percent of total billed charges,32% of total billed charges,249.92,71,,,percent of total billed charges,71% of total billed charges,249.92,71,,,percent of total billed charges,71% of total billed charges,235.84,67,,,percent of total billed charges,67% of total billed charges,235.84,67,,,percent of total billed charges,67% of total billed charges,249.92,71,,,percent of total billed charges,71% of total billed charges,267.52,76,,,percent of total billed charges,76% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,116.02,32.96,,,percent of total billed charges,32.96% of total billed charges,36.73,105,,,Fee Schedule,pays based on EAPG rates,316.8,90,,,percent of total billed charges,90% of total billed charges,316.8,90,,,percent of total billed charges,90% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,311.87,88.6,,,percent of total billed charges,88.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,112.64,32,,,percent of total billed charges,32% of total billed charges,281.6,80,,,percent of total billed charges,80% of total billed charges,281.6,80,,,percent of total billed charges,80% of total billed charges,34.98,100,,,Fee Schedule,pays based on EAPG rates,320.32,91,,,percent of total billed charges,91% of total billed charges,114.89,32.64,,,percent of total billed charges,32.64% of total billed charges,112.64,32,,,percent of total billed charges,32% of total billed charges,118.27,33.6,,,percent of total billed charges,33.6% of total billed charges,36.03,103,,,Fee Schedule,pays based on EAPG rates,112.64,32,,,percent of total billed charges,32% of total billed charges,112.64,32,,,percent of total billed charges,32% of total billed charges,323.84,92,,,percent of total billed charges,92% of total billed charges,34.98,323.84,
DEXA HFV,4000273,CDM,320,RC,77080,HCPCS,Outpatient,,,173,147.05,,140.48,81.2,,,percent of total billed charges,81.2% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,128.02,74,,,percent of total billed charges,74% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,46.28,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,115.91,67,,,percent of total billed charges,67% of total billed charges,122.83,71,,,percent of total billed charges,71% of total billed charges,131.48,76,,,percent of total billed charges,76% of total billed charges,46.28,103,,,Fee Schedule,pays based on EAPG rates,57.02,32.96,,,percent of total billed charges,32.96% of total billed charges,47.18,105,,,Fee Schedule,pays based on EAPG rates,155.7,90,,,percent of total billed charges,90% of total billed charges,155.7,90,,,percent of total billed charges,90% of total billed charges,44.93,100,,,Fee Schedule,pays based on EAPG rates,153.28,88.6,,,percent of total billed charges,88.6% of total billed charges,46.28,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,138.4,80,,,percent of total billed charges,80% of total billed charges,44.93,100,,,Fee Schedule,pays based on EAPG rates,157.43,91,,,percent of total billed charges,91% of total billed charges,56.47,32.64,,,percent of total billed charges,32.64% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,58.13,33.6,,,percent of total billed charges,33.6% of total billed charges,46.28,103,,,Fee Schedule,pays based on EAPG rates,55.36,32,,,percent of total billed charges,32% of total billed charges,55.36,32,,,percent of total billed charges,32% of total billed charges,159.16,92,,,percent of total billed charges,92% of total billed charges,44.93,159.16,
DEXA SPINE/HIPS,4000272,CDM,320,RC,77080,HCPCS,Outpatient,,,596,506.6,,483.95,81.2,,,percent of total billed charges,81.2% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,441.04,74,,,percent of total billed charges,74% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,46.28,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,399.32,67,,,percent of total billed charges,67% of total billed charges,423.16,71,,,percent of total billed charges,71% of total billed charges,452.96,76,,,percent of total billed charges,76% of total billed charges,46.28,103,,,Fee Schedule,pays based on EAPG rates,196.44,32.96,,,percent of total billed charges,32.96% of total billed charges,47.18,105,,,Fee Schedule,pays based on EAPG rates,536.4,90,,,percent of total billed charges,90% of total billed charges,536.4,90,,,percent of total billed charges,90% of total billed charges,44.93,100,,,Fee Schedule,pays based on EAPG rates,528.06,88.6,,,percent of total billed charges,88.6% of total billed charges,46.28,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,476.8,80,,,percent of total billed charges,80% of total billed charges,44.93,100,,,Fee Schedule,pays based on EAPG rates,542.36,91,,,percent of total billed charges,91% of total billed charges,194.53,32.64,,,percent of total billed charges,32.64% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,200.26,33.6,,,percent of total billed charges,33.6% of total billed charges,46.28,103,,,Fee Schedule,pays based on EAPG rates,190.72,32,,,percent of total billed charges,32% of total billed charges,190.72,32,,,percent of total billed charges,32% of total billed charges,548.32,92,,,percent of total billed charges,92% of total billed charges,44.93,548.32,
CREATININE CLEARANCE,4000279,CDM,301,RC,82565,HCPCS,Outpatient,,,84,71.4,,68.21,81.2,,,percent of total billed charges,81.2% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,62.16,74,,,percent of total billed charges,74% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,56.28,67,,,percent of total billed charges,67% of total billed charges,59.64,71,,,percent of total billed charges,71% of total billed charges,63.84,76,,,percent of total billed charges,76% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,27.69,32.96,,,percent of total billed charges,32.96% of total billed charges,7.6,105,,,Fee Schedule,pays based on EAPG rates,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,74.42,88.6,,,percent of total billed charges,88.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,67.2,80,,,percent of total billed charges,80% of total billed charges,7.24,100,,,Fee Schedule,pays based on EAPG rates,76.44,91,,,percent of total billed charges,91% of total billed charges,27.42,32.64,,,percent of total billed charges,32.64% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,28.22,33.6,,,percent of total billed charges,33.6% of total billed charges,7.45,103,,,Fee Schedule,pays based on EAPG rates,26.88,32,,,percent of total billed charges,32% of total billed charges,26.88,32,,,percent of total billed charges,32% of total billed charges,77.28,92,,,percent of total billed charges,92% of total billed charges,7.24,77.28,
CONTRAST OMNIPAQUE 240 10ML,4000382,CDM,636,RC,Q9966,HCPCS,Outpatient,,,344,292.4,,279.33,81.2,,,percent of total billed charges,81.2% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,261.44,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,113.38,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,304.78,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,313.04,91,,,percent of total billed charges,91% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,115.58,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,316.48,92,,,percent of total billed charges,92% of total billed charges,15.39,316.48,
CONTRAST OMNIPAQUE 300 100ML,4000381,CDM,636,RC,Q9967,HCPCS,Outpatient,,,344,292.4,,279.33,81.2,,,percent of total billed charges,81.2% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,261.44,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,113.38,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,304.78,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,313.04,91,,,percent of total billed charges,91% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,115.58,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,316.48,92,,,percent of total billed charges,92% of total billed charges,15.39,316.48,
CONTRAST OMNIPAQUE 350 100ML,4000380,CDM,636,RC,Q9967,HCPCS,Outpatient,,,344,292.4,,279.33,81.2,,,percent of total billed charges,81.2% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,261.44,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,113.38,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,304.78,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,313.04,91,,,percent of total billed charges,91% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,115.58,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,316.48,92,,,percent of total billed charges,92% of total billed charges,15.39,316.48,
CONTRAST OMNIPAQUE 350 50ML,4000378,CDM,636,RC,Q9967,HCPCS,Outpatient,,,344,292.4,,279.33,81.2,,,percent of total billed charges,81.2% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,261.44,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,113.38,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,304.78,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,313.04,91,,,percent of total billed charges,91% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,115.58,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,316.48,92,,,percent of total billed charges,92% of total billed charges,15.39,316.48,
CONTRAST OMNIPAQUE 350 75ML,4000379,CDM,636,RC,Q9967,HCPCS,Outpatient,,,344,292.4,,279.33,81.2,,,percent of total billed charges,81.2% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,254.56,74,,,percent of total billed charges,74% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,230.48,67,,,percent of total billed charges,67% of total billed charges,244.24,71,,,percent of total billed charges,71% of total billed charges,261.44,76,,,percent of total billed charges,76% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,113.38,32.96,,,percent of total billed charges,32.96% of total billed charges,16.16,105,,,Fee Schedule,pays based on EAPG rates,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,304.78,88.6,,,percent of total billed charges,88.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,275.2,80,,,percent of total billed charges,80% of total billed charges,15.39,100,,,Fee Schedule,pays based on EAPG rates,313.04,91,,,percent of total billed charges,91% of total billed charges,112.28,32.64,,,percent of total billed charges,32.64% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,115.58,33.6,,,percent of total billed charges,33.6% of total billed charges,15.85,103,,,Fee Schedule,pays based on EAPG rates,110.08,32,,,percent of total billed charges,32% of total billed charges,110.08,32,,,percent of total billed charges,32% of total billed charges,316.48,92,,,percent of total billed charges,92% of total billed charges,15.39,316.48,
EKG INTERPRETATION FEE,5400050,CDM,985,RC,93010,HCPCS,Outpatient,,,43,36.55,,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,16.95,190,,,Fee Schedule,pays based on BCBS Fee Schedule,16.95,190,,,Fee Schedule,pays based on BCBS Fee Schedule,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,16.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,16.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,16.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,16.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,16.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,16.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.4,80,,,percent of total billed charges,80% of total billed charges,1.24,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.2,40,,,percent of total billed charges,40% of total billed charges,0.62,34.4,
CARDIAC EVENT INTERP FEE,5400049,CDM,985,RC,93272,HCPCS,Outpatient,,,46,39.1,,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,48.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,48.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,48.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,48.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,48.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,48.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,36.8,80,,,percent of total billed charges,80% of total billed charges,2.93,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,18.4,40,,,percent of total billed charges,40% of total billed charges,1.47,48.64,
INJECTION EXT VENOGRAPHY,8500005,CDM,969,RC,36005,HCPCS,Outpatient,,,153,130.05,,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,91.22,190,,,Fee Schedule,pays based on BCBS Fee Schedule,91.22,190,,,Fee Schedule,pays based on BCBS Fee Schedule,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,91.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,91.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,91.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,91.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,91.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,91.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,122.4,80,,,percent of total billed charges,80% of total billed charges,15.06,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,61.2,40,,,percent of total billed charges,40% of total billed charges,7.53,122.4,
INSERT TUNNELED CV CATH W/O PORT,8500051,CDM,969,RC,36558,HCPCS,Outpatient,,,772,656.2,,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,617.6,80,,,percent of total billed charges,80% of total billed charges,64.17,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,32.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,308.8,40,,,percent of total billed charges,40% of total billed charges,32.08,617.6,
INSET TUNNELED CV CATH W PORT,8500004,CDM,969,RC,36561,HCPCS,Outpatient,,,1058,899.3,,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,675.91,190,,,Fee Schedule,pays based on BCBS Fee Schedule,675.91,190,,,Fee Schedule,pays based on BCBS Fee Schedule,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,675.91,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,675.91,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,675.91,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,675.91,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,675.91,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,675.91,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,846.4,80,,,percent of total billed charges,80% of total billed charges,93.08,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,423.2,40,,,percent of total billed charges,40% of total billed charges,46.54,846.4,
REPLACE TUNNELED CV CATH,8500003,CDM,969,RC,36581,HCPCS,Outpatient,,,576,489.6,,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,416.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,416.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,416.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,416.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,416.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,416.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,416.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,416.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,460.8,80,,,percent of total billed charges,80% of total billed charges,42.83,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,21.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,230.4,40,,,percent of total billed charges,40% of total billed charges,21.41,460.8,
REMOVAL TUNNELED CV CATH,8500002,CDM,969,RC,36589,HCPCS,Outpatient,,,428,363.8,,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,280.95,190,,,Fee Schedule,pays based on BCBS Fee Schedule,280.95,190,,,Fee Schedule,pays based on BCBS Fee Schedule,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,280.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,280.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,280.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,280.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,280.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,280.95,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,342.4,80,,,percent of total billed charges,80% of total billed charges,34.02,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,171.2,40,,,percent of total billed charges,40% of total billed charges,17.01,342.4,
AV FUSE UPPR ARM BASILIC,8500054,CDM,969,RC,36819,HCPCS,Outpatient,,,2218,1885.3,,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1774.4,80,,,percent of total billed charges,80% of total billed charges,297.2,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,148.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,887.2,40,,,percent of total billed charges,40% of total billed charges,148.6,1774.4,
AV FUSION DIRECT ANY SITE,8500010,CDM,969,RC,36821,HCPCS,Outpatient,,,2103,1787.55,,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1159.99,190,,,Fee Schedule,pays based on BCBS Fee Schedule,1159.99,190,,,Fee Schedule,pays based on BCBS Fee Schedule,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1159.99,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1159.99,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1159.99,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1159.99,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1159.99,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1159.99,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1682.4,80,,,percent of total billed charges,80% of total billed charges,263.84,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,131.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,841.2,40,,,percent of total billed charges,40% of total billed charges,131.92,1682.4,
ARTERY-VEIN AUTOGRAFT,8500009,CDM,969,RC,36825,HCPCS,Outpatient,,,2517,2139.45,,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1248.22,190,,,Fee Schedule,pays based on BCBS Fee Schedule,1248.22,190,,,Fee Schedule,pays based on BCBS Fee Schedule,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1248.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1248.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1248.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1248.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1248.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1248.22,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2013.6,80,,,percent of total billed charges,80% of total billed charges,317.76,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,158.88,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1006.8,40,,,percent of total billed charges,40% of total billed charges,158.88,2013.6,
ARTERY-VEIN NON AUTOGRAFT,8500008,CDM,969,RC,36830,HCPCS,Outpatient,,,2114,1796.9,,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1411.76,190,,,Fee Schedule,pays based on BCBS Fee Schedule,1411.76,190,,,Fee Schedule,pays based on BCBS Fee Schedule,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1411.76,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1411.76,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1411.76,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1411.76,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1411.76,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,1411.76,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1691.2,80,,,percent of total billed charges,80% of total billed charges,267.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,133.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,845.6,40,,,percent of total billed charges,40% of total billed charges,133.65,1691.2,
OPEN THROMBECT AV FISTULA,8500007,CDM,969,RC,36831,HCPCS,Outpatient,,,1950,1657.5,,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,792.19,190,,,Fee Schedule,pays based on BCBS Fee Schedule,792.19,190,,,Fee Schedule,pays based on BCBS Fee Schedule,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,792.19,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,792.19,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,792.19,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,792.19,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,792.19,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,792.19,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1560,80,,,percent of total billed charges,80% of total billed charges,245.94,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,122.97,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,780,40,,,percent of total billed charges,40% of total billed charges,122.97,1560,
AV FISTULA REVISION OPEN,8500053,CDM,969,RC,36832,HCPCS,Outpatient,,,2291,1947.35,,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1832.8,80,,,percent of total billed charges,80% of total billed charges,300.97,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,150.49,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,916.4,40,,,percent of total billed charges,40% of total billed charges,150.49,1832.8,
DIALYSIS CIRCUIT REVISE W/IN 90 DAYS,8500046,CDM,969,RC,36901,HCPCS,Outpatient,,,534,453.9,,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,281.9,190,,,Fee Schedule,pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,pays based on BCBS Fee Schedule,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,427.2,80,,,percent of total billed charges,80% of total billed charges,48.93,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,213.6,40,,,percent of total billed charges,40% of total billed charges,24.47,427.2,
INTRO CATH DIALYSIS CIRCUIT,8500006,CDM,969,RC,36901,HCPCS,Outpatient,,,534,453.9,,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,281.9,190,,,Fee Schedule,pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,pays based on BCBS Fee Schedule,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,281.9,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,427.2,80,,,percent of total billed charges,80% of total billed charges,48.93,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.47,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,213.6,40,,,percent of total billed charges,40% of total billed charges,24.47,427.2,
DIALYSIS CIRCUIT REVISE W/IN 90 DAYS,8500047,CDM,969,RC,36902,HCPCS,Outpatient,,,764,649.4,,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,420.05,190,,,Fee Schedule,pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,pays based on BCBS Fee Schedule,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,611.2,80,,,percent of total billed charges,80% of total billed charges,69.23,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,305.6,40,,,percent of total billed charges,40% of total billed charges,34.61,611.2,
INTRO CATH DIALYSIS CIRCUIT,8500015,CDM,969,RC,36902,HCPCS,Outpatient,,,764,649.4,,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,420.05,190,,,Fee Schedule,pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,pays based on BCBS Fee Schedule,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,420.05,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,611.2,80,,,percent of total billed charges,80% of total billed charges,69.23,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.61,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,305.6,40,,,percent of total billed charges,40% of total billed charges,34.61,611.2,
DIALYSIS CIRCUIT REVISE W/IN 90 DAYS,8500048,CDM,969,RC,36903,HCPCS,Outpatient,,,953,810.05,,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,762.4,80,,,percent of total billed charges,80% of total billed charges,97.47,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,381.2,40,,,percent of total billed charges,40% of total billed charges,48.73,762.4,
INTRO CATH DIALYSIS CIRCUIT,8500044,CDM,969,RC,36903,HCPCS,Outpatient,,,953,810.05,,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,762.4,80,,,percent of total billed charges,80% of total billed charges,97.47,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48.73,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,381.2,40,,,percent of total billed charges,40% of total billed charges,48.73,762.4,
THRMBC/NFS DIALYSIS CIRCUIT,8500014,CDM,969,RC,36905,HCPCS,Outpatient,,,1413,1201.05,,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,831.23,190,,,Fee Schedule,pays based on BCBS Fee Schedule,831.23,190,,,Fee Schedule,pays based on BCBS Fee Schedule,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,831.23,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,831.23,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,831.23,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,831.23,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,831.23,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,831.23,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1130.4,80,,,percent of total billed charges,80% of total billed charges,120.86,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,565.2,40,,,percent of total billed charges,40% of total billed charges,60.43,1130.4,
THRMBC/NFS DIALYSIS CIRCUIT,8500052,CDM,969,RC,36906,HCPCS,Outpatient,,,1528,1298.8,,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1222.4,80,,,percent of total billed charges,80% of total billed charges,145.6,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,72.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,611.2,40,,,percent of total billed charges,40% of total billed charges,72.8,1222.4,
TRANSLUMINAL BALLOON ANGOPLASTY,8500055,CDM,969,RC,36907,HCPCS,Outpatient,,,429,364.65,,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,343.2,80,,,percent of total billed charges,80% of total billed charges,43.05,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,21.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,171.6,40,,,percent of total billed charges,40% of total billed charges,21.52,343.2,
LIGATION OF A-V FISTULA,8500045,CDM,969,RC,37607,HCPCS,Outpatient,,,1236,1050.6,,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,988.8,80,,,percent of total billed charges,80% of total billed charges,137.18,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,68.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,494.4,40,,,percent of total billed charges,40% of total billed charges,68.59,988.8,
RENAL BIOPSY PERQ,8500013,CDM,969,RC,50200,HCPCS,Outpatient,,,403,342.55,,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,311.13,190,,,Fee Schedule,pays based on BCBS Fee Schedule,311.13,190,,,Fee Schedule,pays based on BCBS Fee Schedule,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,311.13,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,311.13,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,311.13,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,311.13,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,311.13,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,311.13,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,322.4,80,,,percent of total billed charges,80% of total billed charges,25.75,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,161.2,40,,,percent of total billed charges,40% of total billed charges,12.87,322.4,
US GUIDE FOR BIOPSY,8500012,CDM,969,RC,76942,HCPCS,Outpatient,,,100,85,,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,180.14,190,,,Fee Schedule,pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,pays based on BCBS Fee Schedule,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,80,80,,,percent of total billed charges,80% of total billed charges,6.38,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,40,40,,,percent of total billed charges,40% of total billed charges,3.19,180.14,
MOD SEDATION INIT 15M >5YRS,8500049,CDM,969,RC,99152,HCPCS,Outpatient,,,37,31.45,,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,29.6,80,,,percent of total billed charges,80% of total billed charges,3.02,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.8,40,,,percent of total billed charges,40% of total billed charges,1.51,29.6,
MOD SEDATION EA ADDTL 15M,8500050,CDM,969,RC,99153,HCPCS,Outpatient,,,8,6.8,,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.4,80,,,percent of total billed charges,80% of total billed charges,2.18,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.2,40,,,percent of total billed charges,40% of total billed charges,1.09,6.4,
NEW PT 15-29M OR SF MDM,8500017,CDM,969,RC,99202,HCPCS,Outpatient,,,156,132.6,,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,99.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,124.8,80,,,percent of total billed charges,80% of total billed charges,8.92,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.4,40,,,percent of total billed charges,40% of total billed charges,4.46,124.8,
NEW PT 30-44M OR LOW LVL MDM,8500018,CDM,969,RC,99203,HCPCS,Outpatient,,,234,198.9,,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,187.2,80,,,percent of total billed charges,80% of total billed charges,17.09,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,91.4,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.55,187.2,
OP CONSULT NEW PT LOW 30-44,8500030,CDM,969,RC,99203,HCPCS,Outpatient,,,234,198.9,,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,187.2,80,,,percent of total billed charges,80% of total billed charges,17.09,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,91.4,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.55,187.2,
NEW PT 45-59M OR MOD LVL MDM,8500019,CDM,969,RC,99204,HCPCS,Outpatient,,,397,337.45,,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,317.6,80,,,percent of total billed charges,80% of total billed charges,26.24,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,154.58,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,13.12,317.6,
OP CONSULT NEW PT MOD 45-59,8500031,CDM,969,RC,99204,HCPCS,Outpatient,,,397,337.45,,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,317.6,80,,,percent of total billed charges,80% of total billed charges,26.24,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,154.58,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,13.12,317.6,
NEW PT 60-74M OR HIGH LVL MDM,8500000,CDM,969,RC,99205,HCPCS,Outpatient,,,517,439.45,,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,413.6,80,,,percent of total billed charges,80% of total billed charges,35.96,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,200.96,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,17.98,413.6,
OP CONSULT NEW PT HIGH 60-74,8500032,CDM,969,RC,99205,HCPCS,Outpatient,,,517,439.45,,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,413.6,80,,,percent of total billed charges,80% of total billed charges,35.96,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,200.96,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,17.98,413.6,
EST PT MINIMAL TIME OR MDM,8500020,CDM,969,RC,99211,HCPCS,Outpatient,,,45,38.25,,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,19.8,190,,,Fee Schedule,pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,pays based on BCBS Fee Schedule,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,36,80,,,percent of total billed charges,80% of total billed charges,1.28,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,18,40,,,percent of total billed charges,40% of total billed charges,0.64,36,
EST PT 10-19M OR SF MDM,8500021,CDM,969,RC,99212,HCPCS,Outpatient,,,78,66.3,,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,50.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.4,80,,,percent of total billed charges,80% of total billed charges,6.67,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,30.32,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,3.34,62.4,
EST PT 20-29M OR LOW LVL MDM,8500022,CDM,969,RC,99213,HCPCS,Outpatient,,,157,133.45,,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,125.6,80,,,percent of total billed charges,80% of total billed charges,11.53,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.23,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,5.76,125.6,
OP CONSULT EST PT LOW 20-29,8500033,CDM,969,RC,99213,HCPCS,Outpatient,,,157,133.45,,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,125.6,80,,,percent of total billed charges,80% of total billed charges,11.53,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.23,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,5.76,125.6,
EST PT 30-39M OR MOD LVL MDM,8500001,CDM,969,RC,99214,HCPCS,Outpatient,,,242,205.7,,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,193.6,80,,,percent of total billed charges,80% of total billed charges,16.42,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,93.11,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.21,193.6,
EST PT 30-39M OR MOD LVL MDM W/MOD 24,8500042,CDM,969,RC,99214,HCPCS,Outpatient,,,242,205.7,,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,193.6,80,,,percent of total billed charges,80% of total billed charges,16.42,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,93.11,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.21,193.6,
OP CONSULT EST PT MOD 30-39,8500034,CDM,969,RC,99214,HCPCS,Outpatient,,,242,205.7,,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,193.6,80,,,percent of total billed charges,80% of total billed charges,16.42,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,93.11,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.21,193.6,
EST PT 40-54M OR HIGH LVL MDM,8500023,CDM,969,RC,99215,HCPCS,Outpatient,,,341,289.85,,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,272.8,80,,,percent of total billed charges,80% of total billed charges,25.31,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,132.28,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,12.66,272.8,
EST PT 40-54M OR HIGH LVL MDM W/ MOD 24,8500043,CDM,969,RC,99215,HCPCS,Outpatient,,,341,289.85,,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,272.8,80,,,percent of total billed charges,80% of total billed charges,25.31,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,132.28,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,12.66,272.8,
OP CONSULT EST PT HIGH 40-54,8500035,CDM,969,RC,99215,HCPCS,Outpatient,,,341,289.85,,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,272.8,80,,,percent of total billed charges,80% of total billed charges,25.31,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,132.28,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,12.66,272.8,
IP/OBSV CONSULT STFWD 40,8500024,CDM,969,RC,99221,HCPCS,Outpatient,,,157,133.45,,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,125.6,80,,,percent of total billed charges,80% of total billed charges,18.68,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.8,40,,,percent of total billed charges,40% of total billed charges,9.34,125.6,
IP/OBSV CONSULT MOD 55,8500025,CDM,969,RC,99222,HCPCS,Outpatient,,,250,212.5,,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,200,80,,,percent of total billed charges,80% of total billed charges,25.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,163.1,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,12.65,200,
IP/OBSV CONSULT HIGH 75,8500026,CDM,969,RC,99223,HCPCS,Outpatient,,,327,277.95,,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,261.6,80,,,percent of total billed charges,80% of total billed charges,30.08,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,241.44,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,15.04,261.6,
IP/OBSV SUBQ CONSULT STFWD/LOW 25,8500027,CDM,969,RC,99231,HCPCS,Outpatient,,,99,84.15,,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,79.2,80,,,percent of total billed charges,80% of total billed charges,9.81,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,39.6,40,,,percent of total billed charges,40% of total billed charges,4.91,79.2,
IP/OBSV SUBQ CONSULT MOD 35,8500028,CDM,969,RC,99232,HCPCS,Outpatient,,,142,120.7,,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,113.6,80,,,percent of total billed charges,80% of total billed charges,13.82,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,85.96,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,6.91,113.6,
IP/OBSV SUBQ CONSULT HIGH 50,8500029,CDM,969,RC,99233,HCPCS,Outpatient,,,170,144.5,,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,136,80,,,percent of total billed charges,80% of total billed charges,20.75,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,123.9,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,10.37,136,
OP CONSULT DETAILED LOW 30,8500039,CDM,969,RC,99243,HCPCS,Outpatient,,,220,187,,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,176,80,,,percent of total billed charges,80% of total billed charges,13.59,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88,40,,,percent of total billed charges,40% of total billed charges,6.8,176,
OP CONSULT COMPREH MOD 40,8500040,CDM,969,RC,99244,HCPCS,Outpatient,,,279,237.15,,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,223.2,80,,,percent of total billed charges,80% of total billed charges,20.11,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,184.34,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,10.06,223.2,
OP CONSULT COMPREH HIGH 55,8500041,CDM,969,RC,99245,HCPCS,Outpatient,,,304,258.4,,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,243.2,80,,,percent of total billed charges,80% of total billed charges,28.2,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,121.6,40,,,percent of total billed charges,40% of total billed charges,14.1,243.2,
IP/OBSV CONSULT LOW 45,8500036,CDM,969,RC,99253,HCPCS,Outpatient,,,254,215.9,,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,203.2,80,,,percent of total billed charges,80% of total billed charges,15.02,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,101.6,40,,,percent of total billed charges,40% of total billed charges,7.51,203.2,
IP/OBSV CONSULT MOD 60,8500037,CDM,969,RC,99254,HCPCS,Outpatient,,,341,289.85,,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,272.8,80,,,percent of total billed charges,80% of total billed charges,20.34,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,136.4,40,,,percent of total billed charges,40% of total billed charges,10.17,272.8,
IP/OBSV CONSULT HIGH 80,8500038,CDM,969,RC,99255,HCPCS,Outpatient,,,441,374.85,,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,352.8,80,,,percent of total billed charges,80% of total billed charges,28.53,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,176.4,40,,,percent of total billed charges,40% of total billed charges,14.27,352.8,
CONSULT SB SF/LOW MDM 25,8500056,CDM,969,RC,99304,HCPCS,Outpatient,,,236,200.6,,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,188.8,80,,,percent of total billed charges,80% of total billed charges,13.12,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,94.4,40,,,percent of total billed charges,40% of total billed charges,6.56,188.8,
CONSULT SB MOD MDM 35,8500057,CDM,969,RC,99305,HCPCS,Outpatient,,,390,331.5,,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,312,80,,,percent of total billed charges,80% of total billed charges,20.81,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,156,40,,,percent of total billed charges,40% of total billed charges,10.41,312,
CONSULT SB HIGH MDM 45,8500058,CDM,969,RC,99306,HCPCS,Outpatient,,,533,453.05,,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,426.4,80,,,percent of total billed charges,80% of total billed charges,28.27,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,213.2,40,,,percent of total billed charges,40% of total billed charges,14.13,426.4,
SUBQ CONSULT SB SF MDM 10,8500059,CDM,969,RC,99307,HCPCS,Outpatient,,,115,97.75,,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,92,80,,,percent of total billed charges,80% of total billed charges,6.17,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46,40,,,percent of total billed charges,40% of total billed charges,3.09,92,
SUBQ CONSULT SB LOW MDM 15,8500060,CDM,969,RC,99308,HCPCS,Outpatient,,,217,184.45,,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,173.6,80,,,percent of total billed charges,80% of total billed charges,11.23,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,80.69,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,5.62,173.6,
SUBQ CONSULT SB MOD MDM 30,8500061,CDM,969,RC,99309,HCPCS,Outpatient,,,311,264.35,,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,248.8,80,,,percent of total billed charges,80% of total billed charges,16.23,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,107.11,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.12,248.8,
SUBQ CONSULT SB HIGH MDM 45,8500062,CDM,969,RC,99310,HCPCS,Outpatient,,,448,380.8,,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,358.4,80,,,percent of total billed charges,80% of total billed charges,24.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,179.2,40,,,percent of total billed charges,40% of total billed charges,12.15,358.4,
BONE MARROW ASPIR.ONLY PC,8200064,CDM,960,RC,38220,HCPCS,Outpatient,,,268,227.8,,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,214.4,80,,,percent of total billed charges,80% of total billed charges,11.57,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,107.2,40,,,percent of total billed charges,40% of total billed charges,5.78,214.4,
BONE MARROW BX PC ONLY,8200063,CDM,960,RC,38221,HCPCS,Outpatient,,,268,227.8,,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,214.4,80,,,percent of total billed charges,80% of total billed charges,11.74,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,107.2,40,,,percent of total billed charges,40% of total billed charges,5.87,214.4,
BONE MARROW ASPIR. & BX PC,8200065,CDM,960,RC,38222,HCPCS,Outpatient,,,322,273.7,,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,257.6,80,,,percent of total billed charges,80% of total billed charges,13.57,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,128.8,40,,,percent of total billed charges,40% of total billed charges,6.79,257.6,
NEW PT 15-29M OR SF MDM,8200002,CDM,960,RC,99202,HCPCS,Outpatient,,,156,132.6,,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,99.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,124.8,80,,,percent of total billed charges,80% of total billed charges,8.92,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.4,40,,,percent of total billed charges,40% of total billed charges,4.46,124.8,
OP CONSULT NEW PT SF 15-29,8200017,CDM,960,RC,99202,HCPCS,Outpatient,,,156,132.6,,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,99.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,124.8,80,,,percent of total billed charges,80% of total billed charges,8.92,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.4,40,,,percent of total billed charges,40% of total billed charges,4.46,124.8,
NEW PT 30-44M OR LOW LVL MDM,8200003,CDM,960,RC,99203,HCPCS,Outpatient,,,234,198.9,,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,187.2,80,,,percent of total billed charges,80% of total billed charges,17.09,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,91.4,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.55,187.2,
OP CONSULT NEW PT LOW 30-44,8200018,CDM,960,RC,99203,HCPCS,Outpatient,,,234,198.9,,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,187.2,80,,,percent of total billed charges,80% of total billed charges,17.09,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,91.4,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.55,187.2,
NEW PT 45-59M OR MOD LVL MDM,8200004,CDM,960,RC,99204,HCPCS,Outpatient,,,397,337.45,,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,317.6,80,,,percent of total billed charges,80% of total billed charges,26.24,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,154.58,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,13.12,317.6,
OP CONSULT NEW PT MOD 45-59,8200019,CDM,960,RC,99204,HCPCS,Outpatient,,,397,337.45,,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,317.6,80,,,percent of total billed charges,80% of total billed charges,26.24,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,154.58,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,13.12,317.6,
NEW PT 60-74M OR HIGH LVL MDM,8200005,CDM,960,RC,99205,HCPCS,Outpatient,,,517,439.45,,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,413.6,80,,,percent of total billed charges,80% of total billed charges,35.96,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,200.96,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,17.98,413.6,
OP CONSULT NEW PT HIGH 60-74,8200020,CDM,960,RC,99205,HCPCS,Outpatient,,,517,439.45,,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,413.6,80,,,percent of total billed charges,80% of total billed charges,35.96,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,200.96,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,17.98,413.6,
EST PT MINIMAL TIME OR MDM,8200006,CDM,960,RC,99211,HCPCS,Outpatient,,,45,38.25,,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,19.8,190,,,Fee Schedule,pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,pays based on BCBS Fee Schedule,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,36,80,,,percent of total billed charges,80% of total billed charges,1.28,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,18,40,,,percent of total billed charges,40% of total billed charges,0.64,36,
OP CONSULT MINIMAL TIME OR MDM,8200078,CDM,960,RC,99211,HCPCS,Outpatient,,,53,45.05,,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,19.8,190,,,Fee Schedule,pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,pays based on BCBS Fee Schedule,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,42.4,80,,,percent of total billed charges,80% of total billed charges,1.28,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,21.2,40,,,percent of total billed charges,40% of total billed charges,0.64,42.4,
EST PT 10-19M OR SF MDM,8200007,CDM,960,RC,99212,HCPCS,Outpatient,,,78,66.3,,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,50.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.4,80,,,percent of total billed charges,80% of total billed charges,6.67,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,30.32,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,3.34,62.4,
OP CONSULT EST SF 10-19,8200077,CDM,960,RC,99212,HCPCS,Outpatient,,,78,66.3,,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,50.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.4,80,,,percent of total billed charges,80% of total billed charges,6.67,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,30.32,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,3.34,62.4,
EST PT 20-29M OR LOW LVL MDM,8200008,CDM,960,RC,99213,HCPCS,Outpatient,,,157,133.45,,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,125.6,80,,,percent of total billed charges,80% of total billed charges,11.53,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.23,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,5.76,125.6,
OP CONSULT EST PT LOW 20-29,8200076,CDM,960,RC,99213,HCPCS,Outpatient,,,157,133.45,,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,125.6,80,,,percent of total billed charges,80% of total billed charges,11.53,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.23,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,5.76,125.6,
EST PT 30-39M OR MOD LVL MDM,8200009,CDM,960,RC,99214,HCPCS,Outpatient,,,242,205.7,,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,193.6,80,,,percent of total billed charges,80% of total billed charges,16.42,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,93.11,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.21,193.6,
OP CONSULT EST PT MOD 30-39,8200075,CDM,960,RC,99214,HCPCS,Outpatient,,,242,205.7,,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,193.6,80,,,percent of total billed charges,80% of total billed charges,16.42,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,93.11,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.21,193.6,
EST PT 40-54M OR HIGH LVL MDM,8200010,CDM,960,RC,99215,HCPCS,Outpatient,,,341,289.85,,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,272.8,80,,,percent of total billed charges,80% of total billed charges,25.31,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,132.28,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,12.66,272.8,
OP CONSULT EST PT HIGH 40-54,8200074,CDM,960,RC,99215,HCPCS,Outpatient,,,341,289.85,,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,272.8,80,,,percent of total billed charges,80% of total billed charges,25.31,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,132.28,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,12.66,272.8,
IP/OBSV CONSULT STFWD 40,8200025,CDM,960,RC,99221,HCPCS,Outpatient,,,157,133.45,,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,125.6,80,,,percent of total billed charges,80% of total billed charges,18.68,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.8,40,,,percent of total billed charges,40% of total billed charges,9.34,125.6,
IP/OBSV CONSULT MOD 55,8200026,CDM,960,RC,99222,HCPCS,Outpatient,,,250,212.5,,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,200,80,,,percent of total billed charges,80% of total billed charges,25.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,163.1,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,12.65,200,
IP/OBSV CONSULT HIGH 75,8200027,CDM,960,RC,99223,HCPCS,Outpatient,,,327,277.95,,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,261.6,80,,,percent of total billed charges,80% of total billed charges,30.08,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,15.04,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,241.44,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,15.04,261.6,
IP/OBSV SUBQ CONSULT STFWD/LOW 25,8200028,CDM,960,RC,99231,HCPCS,Outpatient,,,99,84.15,,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,79.2,80,,,percent of total billed charges,80% of total billed charges,9.81,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,39.6,40,,,percent of total billed charges,40% of total billed charges,4.91,79.2,
IP/OBSV SUBQ CONSULT MOD 35,8200029,CDM,960,RC,99232,HCPCS,Outpatient,,,142,120.7,,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,113.6,80,,,percent of total billed charges,80% of total billed charges,13.82,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.91,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,85.96,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,6.91,113.6,
IP/OBSV SUBQ CONSULT HIGH 50,8200030,CDM,960,RC,99233,HCPCS,Outpatient,,,170,144.5,,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,136,80,,,percent of total billed charges,80% of total billed charges,20.75,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,123.9,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,10.37,136,
OP CONSULT EXPANDED STFWD 20,8200012,CDM,960,RC,99242,HCPCS,Outpatient,,,170,144.5,,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,136,80,,,percent of total billed charges,80% of total billed charges,8.63,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.31,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,68,40,,,percent of total billed charges,40% of total billed charges,4.31,136,
OP CONSULT DETAILED LOW 30,8200013,CDM,960,RC,99243,HCPCS,Outpatient,,,220,187,,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,176,80,,,percent of total billed charges,80% of total billed charges,13.59,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.8,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88,40,,,percent of total billed charges,40% of total billed charges,6.8,176,
OP CONSULT COMPREH MOD 40,8200014,CDM,960,RC,99244,HCPCS,Outpatient,,,279,237.15,,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,223.2,80,,,percent of total billed charges,80% of total billed charges,20.11,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.06,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,184.34,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,10.06,223.2,
OP CONSULT COMPREH HIGH 55,8200015,CDM,960,RC,99245,HCPCS,Outpatient,,,304,258.4,,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,243.2,80,,,percent of total billed charges,80% of total billed charges,28.2,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,121.6,40,,,percent of total billed charges,40% of total billed charges,14.1,243.2,
IP/OBSV CONSULT STFWD 35,8200037,CDM,960,RC,99252,HCPCS,Outpatient,,,193,164.05,,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,154.4,80,,,percent of total billed charges,80% of total billed charges,11.07,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,77.2,40,,,percent of total billed charges,40% of total billed charges,5.53,154.4,
IP/OBSV CONSULT LOW 45,8200038,CDM,960,RC,99253,HCPCS,Outpatient,,,254,215.9,,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,203.2,80,,,percent of total billed charges,80% of total billed charges,15.02,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,101.6,40,,,percent of total billed charges,40% of total billed charges,7.51,203.2,
IP/OBSV CONSULT MOD 60,8200039,CDM,960,RC,99254,HCPCS,Outpatient,,,341,289.85,,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,272.8,80,,,percent of total billed charges,80% of total billed charges,20.34,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.17,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,136.4,40,,,percent of total billed charges,40% of total billed charges,10.17,272.8,
IP/OBSV CONSULT HIGH 80,8200040,CDM,960,RC,99255,HCPCS,Outpatient,,,441,374.85,,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,352.8,80,,,percent of total billed charges,80% of total billed charges,28.53,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,176.4,40,,,percent of total billed charges,40% of total billed charges,14.27,352.8,
CONSULT SB 1ST SF/LOW MDM 25,8200044,CDM,960,RC,99304,HCPCS,Outpatient,,,133,113.05,,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,106.4,80,,,percent of total billed charges,80% of total billed charges,13.12,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.56,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,53.2,40,,,percent of total billed charges,40% of total billed charges,6.56,106.4,
CONSULT SB 1ST MOD MDM 35,8200045,CDM,960,RC,99305,HCPCS,Outpatient,,,170,144.5,,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,136,80,,,percent of total billed charges,80% of total billed charges,20.81,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,68,40,,,percent of total billed charges,40% of total billed charges,10.41,136,
CONSULT SB 1ST HIGH MDM 45,8200046,CDM,960,RC,99306,HCPCS,Outpatient,,,228,193.8,,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,182.4,80,,,percent of total billed charges,80% of total billed charges,28.27,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,91.2,40,,,percent of total billed charges,40% of total billed charges,14.13,182.4,
SUBQ SB CONSULT SF MDM 10,8200050,CDM,960,RC,99307,HCPCS,Outpatient,,,44,37.4,,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,35.2,80,,,percent of total billed charges,80% of total billed charges,6.17,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.09,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.6,40,,,percent of total billed charges,40% of total billed charges,3.09,35.2,
SUBQ SB CONSULT LOW MDM 15,8200047,CDM,960,RC,99308,HCPCS,Outpatient,,,82,69.7,,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,65.6,80,,,percent of total billed charges,80% of total billed charges,11.23,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.62,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,80.69,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,5.62,80.69,
SUBQ SB CONSULT MOD MDM 30,8200048,CDM,960,RC,99309,HCPCS,Outpatient,,,110,93.5,,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88,80,,,percent of total billed charges,80% of total billed charges,16.23,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,107.11,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.12,107.11,
SUBQ SB CONSULT HIGH MDM 45,8200049,CDM,960,RC,99310,HCPCS,Outpatient,,,152,129.2,,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,121.6,80,,,percent of total billed charges,80% of total billed charges,24.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.8,40,,,percent of total billed charges,40% of total billed charges,12.15,121.6,
PROLONGED SERVICE OP EA 15 MIN <120 MIN,8200134,CDM,960,RC,99417,HCPCS,Outpatient,,,91,77.35,,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,72.8,80,,,percent of total billed charges,80% of total billed charges,4.82,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.41,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,36.4,40,,,percent of total billed charges,40% of total billed charges,2.41,72.8,
INJ TENDON / LIGAMENT / CYST,8900010,CDM,960,RC,20550,HCPCS,Outpatient,,,116,98.6,,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,55.21,190,,,Fee Schedule,pays based on BCBS Fee Schedule,55.21,190,,,Fee Schedule,pays based on BCBS Fee Schedule,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,55.21,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,55.21,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,55.21,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,55.21,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,55.21,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,55.21,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,92.8,80,,,percent of total billed charges,80% of total billed charges,9.97,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46.4,40,,,percent of total billed charges,40% of total billed charges,4.99,92.8,
"INJ TRIGGER POINT, 1-2 MUSCLES",8900011,CDM,960,RC,20552,HCPCS,Outpatient,,,109,92.65,,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,67.36,190,,,Fee Schedule,pays based on BCBS Fee Schedule,67.36,190,,,Fee Schedule,pays based on BCBS Fee Schedule,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,67.36,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,67.36,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,67.36,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,67.36,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,67.36,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,67.36,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,87.2,80,,,percent of total billed charges,80% of total billed charges,8.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,43.6,40,,,percent of total billed charges,40% of total billed charges,4.15,87.2,
"INJ TRIGGER POINT, 3 OR MORE MUSCLES",8900012,CDM,960,RC,20553,HCPCS,Outpatient,,,125,106.25,,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,75.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,75.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,75.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,75.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,75.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,75.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,75.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,75.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,100,80,,,percent of total billed charges,80% of total billed charges,9.36,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,50,40,,,percent of total billed charges,40% of total billed charges,4.68,100,
DRAIN / INJECT JOINT / BURSA SMALL LT,8900013,CDM,960,RC,20600,HCPCS,Outpatient,,,104,88.4,,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,83.2,80,,,percent of total billed charges,80% of total billed charges,9.02,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,41.6,40,,,percent of total billed charges,40% of total billed charges,4.51,83.2,
DRAIN / INJECT JOINT / BURSA SMALL RT,8900014,CDM,960,RC,20600,HCPCS,Outpatient,,,104,88.4,,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,83.2,80,,,percent of total billed charges,80% of total billed charges,9.02,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,41.6,40,,,percent of total billed charges,40% of total billed charges,4.51,83.2,
DRAIN / INJ JNT/ BURSA SMALL LT W/ US,8900016,CDM,960,RC,20604,HCPCS,Outpatient,,,136,115.6,,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,108.8,80,,,percent of total billed charges,80% of total billed charges,10.36,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,54.4,40,,,percent of total billed charges,40% of total billed charges,5.18,108.8,
DRAIN / INJ JNT/ BURSA SMALL RT W/ US,8900017,CDM,960,RC,20604,HCPCS,Outpatient,,,136,115.6,,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,108.8,80,,,percent of total billed charges,80% of total billed charges,10.36,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.18,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,54.4,40,,,percent of total billed charges,40% of total billed charges,5.18,108.8,
DRAIN / INJ JNT/ BURSA MED LT,8900019,CDM,960,RC,20605,HCPCS,Outpatient,,,110,93.5,,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88,80,,,percent of total billed charges,80% of total billed charges,9.08,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,44,40,,,percent of total billed charges,40% of total billed charges,4.54,88,
DRAIN / INJ JNT/ BURSA MED RT,8900020,CDM,960,RC,20605,HCPCS,Outpatient,,,110,93.5,,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88,80,,,percent of total billed charges,80% of total billed charges,9.08,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,44,40,,,percent of total billed charges,40% of total billed charges,4.54,88,
DRAIN / INJ JNT/ BURSA MED LT W/ US,8900022,CDM,960,RC,20606,HCPCS,Outpatient,,,154,130.9,,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,123.2,80,,,percent of total billed charges,80% of total billed charges,13.05,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,61.6,40,,,percent of total billed charges,40% of total billed charges,6.52,123.2,
DRAIN / INJ JNT/ BURSA MED RT W/ US,8900023,CDM,960,RC,20606,HCPCS,Outpatient,,,154,130.9,,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,123.2,80,,,percent of total billed charges,80% of total billed charges,13.05,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,61.6,40,,,percent of total billed charges,40% of total billed charges,6.52,123.2,
DRAIN / INJECT JOINT / BURSA LRG LT,8900025,CDM,960,RC,20610,HCPCS,Outpatient,,,133,113.05,,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,106.4,80,,,percent of total billed charges,80% of total billed charges,12.66,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,53.2,40,,,percent of total billed charges,40% of total billed charges,6.33,106.4,
DRAIN / INJECT JOINT / BURSA LRG RT,8900026,CDM,960,RC,20610,HCPCS,Outpatient,,,133,113.05,,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,106.4,80,,,percent of total billed charges,80% of total billed charges,12.66,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,53.2,40,,,percent of total billed charges,40% of total billed charges,6.33,106.4,
DRAIN / INJECT JOINT / BURSA LRG B/L,8900027,CDM,960,RC,20610,HCPCS,Outpatient,,,200,170,,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,160,80,,,percent of total billed charges,80% of total billed charges,12.66,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,80,40,,,percent of total billed charges,40% of total billed charges,6.33,160,
DRAIN / INJECT JOINT / BURSA LRG LT W/US,8900028,CDM,960,RC,20611,HCPCS,Outpatient,,,177,150.45,,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,141.6,80,,,percent of total billed charges,80% of total billed charges,14.99,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,70.8,40,,,percent of total billed charges,40% of total billed charges,7.5,141.6,
DRAIN / INJECT JOINT / BURSA LRG RT W/US,8900029,CDM,960,RC,20611,HCPCS,Outpatient,,,177,150.45,,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,141.6,80,,,percent of total billed charges,80% of total billed charges,14.99,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,70.8,40,,,percent of total billed charges,40% of total billed charges,7.5,141.6,
ABLATE BONE TUMOR(S) PERQ LT,8900110,CDM,960,RC,20982,HCPCS,Outpatient,,,1083,920.55,,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,866.4,80,,,percent of total billed charges,80% of total billed charges,104.41,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,433.2,40,,,percent of total billed charges,40% of total billed charges,52.21,866.4,
ABLATE BONE TUMOR(S) PERQ RT,8900111,CDM,960,RC,20982,HCPCS,Outpatient,,,1083,920.55,,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,866.4,80,,,percent of total billed charges,80% of total billed charges,104.41,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,433.2,40,,,percent of total billed charges,40% of total billed charges,52.21,866.4,
VERTEBROPLASTY LUMBOSACRAL,8900158,CDM,960,RC,22511,HCPCS,Outpatient,,,1197,1017.45,,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,957.6,80,,,percent of total billed charges,80% of total billed charges,105.99,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.99,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,478.8,40,,,percent of total billed charges,40% of total billed charges,52.99,957.6,
KYPHOPLASTY THORACIC,8900112,CDM,960,RC,22513,HCPCS,Outpatient,,,1507,1280.95,,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1205.6,80,,,percent of total billed charges,80% of total billed charges,155.2,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,77.6,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,602.8,40,,,percent of total billed charges,40% of total billed charges,77.6,1205.6,
KYPHOPLASTY LUMBAR,8900113,CDM,960,RC,22514,HCPCS,Outpatient,,,1404,1193.4,,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1123.2,80,,,percent of total billed charges,80% of total billed charges,143.16,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,71.58,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,561.6,40,,,percent of total billed charges,40% of total billed charges,71.58,1123.2,
KYPHOPLASTY EA ADD'L,8900114,CDM,960,RC,22515,HCPCS,Outpatient,,,647,549.95,,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,517.6,80,,,percent of total billed charges,80% of total billed charges,74.28,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,37.14,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,258.8,40,,,percent of total billed charges,40% of total billed charges,37.14,517.6,
ARTHRODISIS LUMBAR PST TQ 1NTRSPC,8900159,CDM,960,RC,22612,HCPCS,Outpatient,,,4718,4010.3,,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3774.4,80,,,percent of total billed charges,80% of total billed charges,612.03,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,306.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1887.2,40,,,percent of total billed charges,40% of total billed charges,306.02,3774.4,
INSERT SPINE FIXATION DEVICE,8900160,CDM,960,RC,22840,HCPCS,Outpatient,,,2261,1921.85,,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1808.8,80,,,percent of total billed charges,80% of total billed charges,340.88,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,170.44,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,904.4,40,,,percent of total billed charges,40% of total billed charges,170.44,1808.8,
INSERT STABLJ DEV W/O LUMBAR SINGLE,8900115,CDM,960,RC,22869,HCPCS,Outpatient,,,1265,1075.25,,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1012,80,,,percent of total billed charges,80% of total billed charges,79.04,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,39.52,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,506,40,,,percent of total billed charges,40% of total billed charges,39.52,1012,
INSERT STABLJ DEV W/O LUMBAR 2ND LVL,8900116,CDM,960,RC,22870,HCPCS,Outpatient,,,348,295.8,,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,278.4,80,,,percent of total billed charges,80% of total billed charges,24.55,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,139.2,40,,,percent of total billed charges,40% of total billed charges,12.27,278.4,
INJECT SACROILIAC JNT LT (FLOURO INC),8900031,CDM,960,RC,27096,HCPCS,Outpatient,,,243,206.55,,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,194.4,80,,,percent of total billed charges,80% of total billed charges,15.58,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,97.2,40,,,percent of total billed charges,40% of total billed charges,7.79,194.4,
INJECT SACROILIAC JNT RT (FLOURO INC),8900032,CDM,960,RC,27096,HCPCS,Outpatient,,,243,206.55,,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,194.4,80,,,percent of total billed charges,80% of total billed charges,15.58,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,97.2,40,,,percent of total billed charges,40% of total billed charges,7.79,194.4,
INJECT SACROILIAC JNT BIL (FLOURO INC),8900155,CDM,960,RC,27096,HCPCS,Outpatient,,,365,310.25,,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,292,80,,,percent of total billed charges,80% of total billed charges,15.58,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,146,40,,,percent of total billed charges,40% of total billed charges,7.79,292,
BRAIN CANAL SHUNT PROCEDURE,8900117,CDM,960,RC,61070,HCPCS,Outpatient,,,166,141.1,,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,132.8,80,,,percent of total billed charges,80% of total billed charges,15.58,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.79,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,66.4,40,,,percent of total billed charges,40% of total billed charges,7.79,132.8,
INJ PROCEDURE DISCOGRAPHY EA LVL LUMBAR,8900118,CDM,960,RC,62290,HCPCS,Outpatient,,,462,392.7,,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,369.6,80,,,percent of total billed charges,80% of total billed charges,29.83,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.92,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,184.8,40,,,percent of total billed charges,40% of total billed charges,14.92,369.6,
EPIDURAL CER/THOR (W/ GUIDE),8900035,CDM,960,RC,62321,HCPCS,Outpatient,,,312,265.2,,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,210.65,190,,,Fee Schedule,pays based on BCBS Fee Schedule,210.65,190,,,Fee Schedule,pays based on BCBS Fee Schedule,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,210.65,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,210.65,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,210.65,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,210.65,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,210.65,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,210.65,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,249.6,80,,,percent of total billed charges,80% of total billed charges,20.86,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,124.8,40,,,percent of total billed charges,40% of total billed charges,10.43,249.6,
EPIDURAL LUM/SAC (W/ GUIDE),8900037,CDM,960,RC,62323,HCPCS,Outpatient,,,290,246.5,,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,192.07,190,,,Fee Schedule,pays based on BCBS Fee Schedule,192.07,190,,,Fee Schedule,pays based on BCBS Fee Schedule,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,192.07,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,192.07,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,192.07,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,192.07,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,192.07,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,192.07,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,232,80,,,percent of total billed charges,80% of total billed charges,19.62,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.81,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,116,40,,,percent of total billed charges,40% of total billed charges,9.81,232,
IMPLANT SPINAL CANAL CATH,8900119,CDM,960,RC,62350,HCPCS,Outpatient,,,1175,998.75,,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,940,80,,,percent of total billed charges,80% of total billed charges,116.51,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,58.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,470,40,,,percent of total billed charges,40% of total billed charges,58.25,940,
IMPLANT SPINE INFUSION PUMP,8900120,CDM,960,RC,62362,HCPCS,Outpatient,,,1141,969.85,,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,912.8,80,,,percent of total billed charges,80% of total billed charges,124.27,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.13,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,456.4,40,,,percent of total billed charges,40% of total billed charges,62.13,912.8,
ANALYZE SPINE INFUS PUMP,8900121,CDM,960,RC,62367,HCPCS,Outpatient,,,71,60.35,,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,56.8,80,,,percent of total billed charges,80% of total billed charges,6.07,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,28.4,40,,,percent of total billed charges,40% of total billed charges,3.03,56.8,
ANALYZE SP INF PUMP W/ REPROG,8900122,CDM,960,RC,62368,HCPCS,Outpatient,,,102,86.7,,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,81.6,80,,,percent of total billed charges,80% of total billed charges,8.16,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,40.8,40,,,percent of total billed charges,40% of total billed charges,4.08,81.6,
ANAL SP INF PMP W/REPRG&FILL,8900123,CDM,960,RC,62369,HCPCS,Outpatient,,,103,87.55,,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,82.4,80,,,percent of total billed charges,80% of total billed charges,8.2,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.1,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,41.2,40,,,percent of total billed charges,40% of total billed charges,4.1,82.4,
IMPLANT NEUROELECTRODES,8900124,CDM,960,RC,63650,HCPCS,Outpatient,,,1214,1031.9,,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,971.2,80,,,percent of total billed charges,80% of total billed charges,87.26,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,43.63,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,485.6,40,,,percent of total billed charges,40% of total billed charges,43.63,971.2,
REVISE/REPLC SPINE ELTRD PERQ ARAY,8900149,CDM,960,RC,63663,HCPCS,Outpatient,,,1330,1130.5,,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1064,80,,,percent of total billed charges,80% of total billed charges,114.17,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,57.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,532,40,,,percent of total billed charges,40% of total billed charges,57.08,1064,
INSRT/REDO SPINE N GENERATOR,8900125,CDM,960,RC,63685,HCPCS,Outpatient,,,1069,908.65,,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,855.2,80,,,percent of total billed charges,80% of total billed charges,105.42,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,52.71,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,427.6,40,,,percent of total billed charges,40% of total billed charges,52.71,855.2,
REVISE/REMOVE NEURORECEIVER,8900126,CDM,960,RC,63688,HCPCS,Outpatient,,,1105,939.25,,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,884,80,,,percent of total billed charges,80% of total billed charges,95.37,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,47.69,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,442,40,,,percent of total billed charges,40% of total billed charges,47.69,884,
NERVE BLOCK INJ TRIGEMINAL,8900038,CDM,960,RC,64400,HCPCS,Outpatient,,,149,126.65,,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,101.02,190,,,Fee Schedule,pays based on BCBS Fee Schedule,101.02,190,,,Fee Schedule,pays based on BCBS Fee Schedule,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,101.02,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,101.02,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,101.02,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,101.02,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,101.02,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,101.02,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,119.2,80,,,percent of total billed charges,80% of total billed charges,19.18,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.59,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,59.6,40,,,percent of total billed charges,40% of total billed charges,9.59,119.2,
NERVE BLOCK INJ OCCIPITAL,8900040,CDM,960,RC,64405,HCPCS,Outpatient,,,157,133.45,,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,117.29,190,,,Fee Schedule,pays based on BCBS Fee Schedule,117.29,190,,,Fee Schedule,pays based on BCBS Fee Schedule,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,117.29,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,117.29,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,117.29,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,117.29,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,117.29,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,117.29,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,125.6,80,,,percent of total billed charges,80% of total billed charges,20.04,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.02,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.8,40,,,percent of total billed charges,40% of total billed charges,10.02,125.6,
NERVE BLOCK INJ BRACHIAL PLEXUS,8900042,CDM,960,RC,64415,HCPCS,Outpatient,,,205,174.25,,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,237.12,190,,,Fee Schedule,pays based on BCBS Fee Schedule,237.12,190,,,Fee Schedule,pays based on BCBS Fee Schedule,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,237.12,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,237.12,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,237.12,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,237.12,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,237.12,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,237.12,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,164,80,,,percent of total billed charges,80% of total billed charges,14.06,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.03,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,82,40,,,percent of total billed charges,40% of total billed charges,7.03,237.12,
NERVE BLOCK AXILLAY NERVE LT,8900127,CDM,960,RC,64417,HCPCS,Outpatient,,,187,158.95,,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.6,80,,,percent of total billed charges,80% of total billed charges,13.74,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,74.8,40,,,percent of total billed charges,40% of total billed charges,6.87,149.6,
NERVE BLOCK AXILLAY NERVE RT,8900128,CDM,960,RC,64417,HCPCS,Outpatient,,,187,158.95,,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.6,80,,,percent of total billed charges,80% of total billed charges,13.74,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,74.8,40,,,percent of total billed charges,40% of total billed charges,6.87,149.6,
NERVE BLOCK INJ SUPRASCAPULAR,8900043,CDM,960,RC,64418,HCPCS,Outpatient,,,165,140.25,,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,225.63,190,,,Fee Schedule,pays based on BCBS Fee Schedule,225.63,190,,,Fee Schedule,pays based on BCBS Fee Schedule,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,225.63,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,225.63,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,225.63,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,225.63,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,225.63,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,225.63,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,132,80,,,percent of total billed charges,80% of total billed charges,12.47,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,66,40,,,percent of total billed charges,40% of total billed charges,6.24,225.63,
NERVE BLOCK INJ INTERCOSTAL SINGLE,8900044,CDM,960,RC,64420,HCPCS,Outpatient,,,172,146.2,,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,120.4,190,,,Fee Schedule,pays based on BCBS Fee Schedule,120.4,190,,,Fee Schedule,pays based on BCBS Fee Schedule,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,120.4,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,120.4,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,120.4,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,120.4,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,120.4,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,120.4,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,137.6,80,,,percent of total billed charges,80% of total billed charges,11.07,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.54,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,68.8,40,,,percent of total billed charges,40% of total billed charges,5.54,137.6,
NERVE BLOCK INJ INTERCOSTAL MULTI LT,8900045,CDM,960,RC,64421,HCPCS,Outpatient,,,72,61.2,,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,57.6,80,,,percent of total billed charges,80% of total billed charges,5.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,28.8,40,,,percent of total billed charges,40% of total billed charges,2.65,57.6,
NERVE BLOCK INJ INTERCOSTAL MULTI RT,8900046,CDM,960,RC,64421,HCPCS,Outpatient,,,72,61.2,,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,57.6,80,,,percent of total billed charges,80% of total billed charges,5.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,2.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,28.8,40,,,percent of total billed charges,40% of total billed charges,2.65,57.6,
NERVE BLOCK INJ ILIO-ING/HYPOG LT,8900048,CDM,960,RC,64425,HCPCS,Outpatient,,,161,136.85,,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,128.8,80,,,percent of total billed charges,80% of total billed charges,10.86,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,64.4,40,,,percent of total billed charges,40% of total billed charges,5.43,128.8,
NERVE BLOCK INJ ILIO-ING/HYPOG RT,8900049,CDM,960,RC,64425,HCPCS,Outpatient,,,161,136.85,,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,128.8,80,,,percent of total billed charges,80% of total billed charges,10.86,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.43,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,64.4,40,,,percent of total billed charges,40% of total billed charges,5.43,128.8,
NERVE BLOCK SCIATIC NERVE LT,8900129,CDM,960,RC,64445,HCPCS,Outpatient,,,216,183.6,,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,172.8,80,,,percent of total billed charges,80% of total billed charges,14.96,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,86.4,40,,,percent of total billed charges,40% of total billed charges,7.48,172.8,
NERVE BLOCK SCIATIC NERVE RT,8900130,CDM,960,RC,64445,HCPCS,Outpatient,,,216,183.6,,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,172.8,80,,,percent of total billed charges,80% of total billed charges,14.96,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.48,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,86.4,40,,,percent of total billed charges,40% of total billed charges,7.48,172.8,
NERVE BLOCK FEMORA LNERVE LT,8900131,CDM,960,RC,64447,HCPCS,Outpatient,,,186,158.1,,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,148.8,80,,,percent of total billed charges,80% of total billed charges,12.14,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,74.4,40,,,percent of total billed charges,40% of total billed charges,6.07,148.8,
NERVE BLOCK FEMORA LNERVE RT,8900132,CDM,960,RC,64447,HCPCS,Outpatient,,,186,158.1,,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,148.8,80,,,percent of total billed charges,80% of total billed charges,12.14,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.07,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,74.4,40,,,percent of total billed charges,40% of total billed charges,6.07,148.8,
NERVE BLOCK INJ OTHER PERIPHERAL LT,8900051,CDM,960,RC,64450,HCPCS,Outpatient,,,123,104.55,,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,98.4,80,,,percent of total billed charges,80% of total billed charges,9.36,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,49.2,40,,,percent of total billed charges,40% of total billed charges,4.68,98.4,
NERVE BLOCK INJ OTHER PERIPHERAL RT,8900052,CDM,960,RC,64450,HCPCS,Outpatient,,,123,104.55,,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,98.4,80,,,percent of total billed charges,80% of total billed charges,9.36,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,49.2,40,,,percent of total billed charges,40% of total billed charges,4.68,98.4,
NERVE BLOCK INJ OTHER PERIPHERAL B/L,8900053,CDM,960,RC,64450,HCPCS,Outpatient,,,185,157.25,,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,148,80,,,percent of total billed charges,80% of total billed charges,9.36,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,74,40,,,percent of total billed charges,40% of total billed charges,4.68,148,
NERVE BLOCK GENICULAR NERVE LT,8900133,CDM,960,RC,64454,HCPCS,Outpatient,,,240,204,,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,192,80,,,percent of total billed charges,80% of total billed charges,15.55,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,96,40,,,percent of total billed charges,40% of total billed charges,7.78,192,
NERVE BLOCK GENICULAR NERVE RT,8900134,CDM,960,RC,64454,HCPCS,Outpatient,,,240,204,,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,192,80,,,percent of total billed charges,80% of total billed charges,15.55,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.78,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,96,40,,,percent of total billed charges,40% of total billed charges,7.78,192,
FORAMIN EPID INJ CER/THOR LT,8900054,CDM,960,RC,64479,HCPCS,Outpatient,,,381,323.85,,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,304.8,80,,,percent of total billed charges,80% of total billed charges,23.72,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,152.4,40,,,percent of total billed charges,40% of total billed charges,11.86,304.8,
FORAMIN EPID INJ CER/THOR RT,8900055,CDM,960,RC,64479,HCPCS,Outpatient,,,381,323.85,,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,304.8,80,,,percent of total billed charges,80% of total billed charges,23.72,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,152.4,40,,,percent of total billed charges,40% of total billed charges,11.86,304.8,
FORAMIN EPID INJ C/T LT EA ADD'L,8900057,CDM,960,RC,64480,HCPCS,Outpatient,,,180,153,,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,144,80,,,percent of total billed charges,80% of total billed charges,12.01,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,72,40,,,percent of total billed charges,40% of total billed charges,6.01,144,
FORAMIN EPID INJ C/T RT EA ADD'L,8900058,CDM,960,RC,64480,HCPCS,Outpatient,,,180,153,,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,144,80,,,percent of total billed charges,80% of total billed charges,12.01,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,72,40,,,percent of total billed charges,40% of total billed charges,6.01,144,
FORAMIN EPID INJ LUM/SAC LT  FLOURO INC,8900060,CDM,960,RC,64483,HCPCS,Outpatient,,,323,274.55,,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,258.4,80,,,percent of total billed charges,80% of total billed charges,20.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,129.2,40,,,percent of total billed charges,40% of total billed charges,10.15,258.4,
FORAMIN EPID INJ LUM/SAC RT  FLOURO INC,8900061,CDM,960,RC,64483,HCPCS,Outpatient,,,323,274.55,,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,258.4,80,,,percent of total billed charges,80% of total billed charges,20.3,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.15,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,129.2,40,,,percent of total billed charges,40% of total billed charges,10.15,258.4,
FORAMIN EPID INJ L/C RT ADD'L FLOURO INC,8900064,CDM,960,RC,64484,HCPCS,Outpatient,,,151,128.35,,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,120.8,80,,,percent of total billed charges,80% of total billed charges,10.69,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.4,40,,,percent of total billed charges,40% of total billed charges,5.35,120.8,
FORAMIN EPID INJ L/S LT ADD'L FLOURO INC,8900063,CDM,960,RC,64484,HCPCS,Outpatient,,,151,128.35,,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,120.8,80,,,percent of total billed charges,80% of total billed charges,10.69,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.35,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.4,40,,,percent of total billed charges,40% of total billed charges,5.35,120.8,
TAP BLOCK BY INJ UNILAT,8900135,CDM,960,RC,64486,HCPCS,Outpatient,,,164,139.4,,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,131.2,80,,,percent of total billed charges,80% of total billed charges,11.7,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.85,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,65.6,40,,,percent of total billed charges,40% of total billed charges,5.85,131.2,
TAP BLOCK BY INJ BILAT,8900136,CDM,960,RC,64488,HCPCS,Outpatient,,,203,172.55,,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,162.4,80,,,percent of total billed charges,80% of total billed charges,14.03,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.01,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,81.2,40,,,percent of total billed charges,40% of total billed charges,7.01,162.4,
MBB CER/THOR LT (FLOURO INC),8900066,CDM,960,RC,64490,HCPCS,Outpatient,,,306,260.1,,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,244.8,80,,,percent of total billed charges,80% of total billed charges,19.95,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,122.4,40,,,percent of total billed charges,40% of total billed charges,9.98,244.8,
MBB CER/THOR RT (FLOURO INC),8900067,CDM,960,RC,64490,HCPCS,Outpatient,,,306,260.1,,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,244.8,80,,,percent of total billed charges,80% of total billed charges,19.95,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,122.4,40,,,percent of total billed charges,40% of total billed charges,9.98,244.8,
MBB CER/THOR B/L (FLOURO INC),8900068,CDM,960,RC,64490,HCPCS,Outpatient,,,459,390.15,,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,367.2,80,,,percent of total billed charges,80% of total billed charges,19.95,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,9.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,183.6,40,,,percent of total billed charges,40% of total billed charges,9.98,367.2,
MBB CER/THOR 2ND LVL (FLOURO INC),8900069,CDM,960,RC,64491,HCPCS,Outpatient,,,174,147.9,,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,139.2,80,,,percent of total billed charges,80% of total billed charges,12.69,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,69.6,40,,,percent of total billed charges,40% of total billed charges,6.34,139.2,
MBB CER/THOR 3RD LVL (FLOURO INC),8900072,CDM,960,RC,64492,HCPCS,Outpatient,,,177,150.45,,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,141.6,80,,,percent of total billed charges,80% of total billed charges,12.74,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.37,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,70.8,40,,,percent of total billed charges,40% of total billed charges,6.37,141.6,
MBB LUM/SAC LT (FLOURO INC),8900075,CDM,960,RC,64493,HCPCS,Outpatient,,,264,224.4,,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.2,80,,,percent of total billed charges,80% of total billed charges,16.78,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,105.6,40,,,percent of total billed charges,40% of total billed charges,8.39,211.2,
MBB LUM/SAC RT (FLOURO INC),8900076,CDM,960,RC,64493,HCPCS,Outpatient,,,264,224.4,,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.2,80,,,percent of total billed charges,80% of total billed charges,16.78,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,105.6,40,,,percent of total billed charges,40% of total billed charges,8.39,211.2,
MBB LUM/SAC B/L (FLOURO INC),8900077,CDM,960,RC,64493,HCPCS,Outpatient,,,396,336.6,,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,316.8,80,,,percent of total billed charges,80% of total billed charges,16.78,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.39,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,158.4,40,,,percent of total billed charges,40% of total billed charges,8.39,316.8,
MBB LUM/SAC 2ND LVL(FLOURO INC),8900078,CDM,960,RC,64494,HCPCS,Outpatient,,,150,127.5,,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,120,80,,,percent of total billed charges,80% of total billed charges,10.66,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.33,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60,40,,,percent of total billed charges,40% of total billed charges,5.33,120,
MBB LUM/SAC 3ND LVL(FLOURO INC),8900081,CDM,960,RC,64495,HCPCS,Outpatient,,,152,129.2,,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,121.6,80,,,percent of total billed charges,80% of total billed charges,10.71,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.36,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.8,40,,,percent of total billed charges,40% of total billed charges,5.36,121.6,
NB SPHENOPALATINE GANGLION,8900137,CDM,960,RC,64505,HCPCS,Outpatient,,,306,260.1,,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,244.8,80,,,percent of total billed charges,80% of total billed charges,34.61,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.3,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,122.4,40,,,percent of total billed charges,40% of total billed charges,17.3,244.8,
NERVE BLOCK STELLATE GANGLION LT,8900084,CDM,960,RC,64510,HCPCS,Outpatient,,,223,189.55,,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,178.4,80,,,percent of total billed charges,80% of total billed charges,13.68,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,89.2,40,,,percent of total billed charges,40% of total billed charges,6.84,178.4,
NERVE BLOCK STELLATE GANGLION RT,8900085,CDM,960,RC,64510,HCPCS,Outpatient,,,223,189.55,,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,178.4,80,,,percent of total billed charges,80% of total billed charges,13.68,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.84,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,89.2,40,,,percent of total billed charges,40% of total billed charges,6.84,178.4,
NB SUPERIOR HYPOGASTRIC PLEXUS,8900138,CDM,960,RC,64517,HCPCS,Outpatient,,,368,312.8,,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,294.4,80,,,percent of total billed charges,80% of total billed charges,21.92,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,10.96,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,147.2,40,,,percent of total billed charges,40% of total billed charges,10.96,294.4,
NB  LUM/THOR SYMPAHETIC LT,8900087,CDM,960,RC,64520,HCPCS,Outpatient,,,245,208.25,,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,196,80,,,percent of total billed charges,80% of total billed charges,14.91,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,98,40,,,percent of total billed charges,40% of total billed charges,7.46,196,
NB  LUM/THOR SYMPAHETIC RT,8900088,CDM,960,RC,64520,HCPCS,Outpatient,,,245,208.25,,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,196,80,,,percent of total billed charges,80% of total billed charges,14.91,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,7.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,98,40,,,percent of total billed charges,40% of total billed charges,7.46,196,
NB CELIAC PLEXUS,8900090,CDM,960,RC,64530,HCPCS,Outpatient,,,276,234.6,,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,178.14,190,,,Fee Schedule,pays based on BCBS Fee Schedule,178.14,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,178.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,178.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,178.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,178.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,178.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,178.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,220.8,80,,,percent of total billed charges,80% of total billed charges,17.01,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.5,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,110.4,40,,,percent of total billed charges,40% of total billed charges,8.5,220.8,
IMPLANT NEUROELECTRODE PERIPHERAL NERVE,8900139,CDM,960,RC,64555,HCPCS,Outpatient,,,956,812.6,,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,764.8,80,,,percent of total billed charges,80% of total billed charges,66.57,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,33.28,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,382.4,40,,,percent of total billed charges,40% of total billed charges,33.28,764.8,
INSRT/REDO PN/GASTR STIMUL,8900140,CDM,960,RC,64590,HCPCS,Outpatient,,,471,400.35,,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,376.8,80,,,percent of total billed charges,80% of total billed charges,73.4,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,36.7,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,188.4,40,,,percent of total billed charges,40% of total billed charges,36.7,376.8,
REVISE/REMV PN/GASTR STIMUL,8900141,CDM,960,RC,64595,HCPCS,Outpatient,,,371,315.35,,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,296.8,80,,,percent of total billed charges,80% of total billed charges,56.5,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,28.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,148.4,40,,,percent of total billed charges,40% of total billed charges,28.25,296.8,
CHEMODENERVATION MUSCLE MIGRAINE,8900091,CDM,960,RC,64615,HCPCS,Outpatient,,,368,312.8,,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,221.77,190,,,Fee Schedule,pays based on BCBS Fee Schedule,221.77,190,,,Fee Schedule,pays based on BCBS Fee Schedule,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,221.77,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,221.77,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,221.77,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,221.77,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,221.77,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,221.77,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,294.4,80,,,percent of total billed charges,80% of total billed charges,55.75,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,27.87,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,147.2,40,,,percent of total billed charges,40% of total billed charges,27.87,294.4,
CHEMODENERVATION MUSCLE NECK DYSTONIA,8900092,CDM,960,RC,64616,HCPCS,Outpatient,,,323,274.55,,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,198.32,190,,,Fee Schedule,pays based on BCBS Fee Schedule,198.32,190,,,Fee Schedule,pays based on BCBS Fee Schedule,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,198.32,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,198.32,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,198.32,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,198.32,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,198.32,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,198.32,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,258.4,80,,,percent of total billed charges,80% of total billed charges,46.48,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,23.24,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,129.2,40,,,percent of total billed charges,40% of total billed charges,23.24,258.4,
DSTRJ BY NEUROLYTIC AGENT GNCLR NRV LT,8900142,CDM,960,RC,64624,HCPCS,Outpatient,,,425,361.25,,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,340,80,,,percent of total billed charges,80% of total billed charges,26.16,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,170,40,,,percent of total billed charges,40% of total billed charges,13.08,340,
DSTRJ BY NEUROLYTIC AGENT GNCLR NRV RT,8900143,CDM,960,RC,64624,HCPCS,Outpatient,,,425,361.25,,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,340,80,,,percent of total billed charges,80% of total billed charges,26.16,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.08,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,170,40,,,percent of total billed charges,40% of total billed charges,13.08,340,
RFA NRV NRVTG SI JT LT,8900144,CDM,960,RC,64625,HCPCS,Outpatient,,,568,482.8,,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,454.4,80,,,percent of total billed charges,80% of total billed charges,35.97,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,227.2,40,,,percent of total billed charges,40% of total billed charges,17.98,454.4,
RFA NRV NRVTG SI JT RT,8900145,CDM,960,RC,64625,HCPCS,Outpatient,,,568,482.8,,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,454.4,80,,,percent of total billed charges,80% of total billed charges,35.97,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,227.2,40,,,percent of total billed charges,40% of total billed charges,17.98,454.4,
TRML DSTRJ IOS BVN 1ST 2 LUM/SAC,8900146,CDM,960,RC,64628,HCPCS,Outpatient,,,1353,1150.05,,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1082.4,80,,,percent of total billed charges,80% of total billed charges,93.35,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,46.68,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,541.2,40,,,percent of total billed charges,40% of total billed charges,46.68,1082.4,
TRML DSTRJ IOS BVN EA ADD'L LUM/SAC,8900147,CDM,960,RC,64629,HCPCS,Outpatient,,,633,538.05,,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,506.4,80,,,percent of total billed charges,80% of total billed charges,49.96,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,24.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,253.2,40,,,percent of total billed charges,40% of total billed charges,24.98,506.4,
RFA CER/THOR LT (FLOURO INC),8900093,CDM,960,RC,64633,HCPCS,Outpatient,,,558,474.3,,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,446.4,80,,,percent of total billed charges,80% of total billed charges,35.77,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,223.2,40,,,percent of total billed charges,40% of total billed charges,17.89,446.4,
RFA CER/THOR RT (FLOURO INC),8900094,CDM,960,RC,64633,HCPCS,Outpatient,,,558,474.3,,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,446.4,80,,,percent of total billed charges,80% of total billed charges,35.77,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,223.2,40,,,percent of total billed charges,40% of total billed charges,17.89,446.4,
RFA CER/THOR BIL (FLOURO INC),8900156,CDM,960,RC,64633,HCPCS,Outpatient,,,837,711.45,,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,669.6,80,,,percent of total billed charges,80% of total billed charges,35.77,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.89,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,334.8,40,,,percent of total billed charges,40% of total billed charges,17.89,669.6,
RFA CER/THOR ADD'L LT (FLOURO INC),8900096,CDM,960,RC,64634,HCPCS,Outpatient,,,196,166.6,,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,156.8,80,,,percent of total billed charges,80% of total billed charges,13.91,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,78.4,40,,,percent of total billed charges,40% of total billed charges,6.95,156.8,
RFA CER/THOR ADD'L RT (FLOURO INC),8900097,CDM,960,RC,64634,HCPCS,Outpatient,,,196,166.6,,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,156.8,80,,,percent of total billed charges,80% of total billed charges,13.91,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,6.95,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,78.4,40,,,percent of total billed charges,40% of total billed charges,6.95,156.8,
RFA LUM/SAC LT (FLOURO INC),8900099,CDM,960,RC,64635,HCPCS,Outpatient,,,559,475.15,,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,447.2,80,,,percent of total billed charges,80% of total billed charges,35.79,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,223.6,40,,,percent of total billed charges,40% of total billed charges,17.9,447.2,
RFA LUM/SAC RT (FLOURO INC),8900100,CDM,960,RC,64635,HCPCS,Outpatient,,,559,475.15,,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,447.2,80,,,percent of total billed charges,80% of total billed charges,35.79,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.9,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,223.6,40,,,percent of total billed charges,40% of total billed charges,17.9,447.2,
RFA LUM/SAC ADD'L LT (FLOURO INC),8900102,CDM,960,RC,64636,HCPCS,Outpatient,,,173,147.05,,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,138.4,80,,,percent of total billed charges,80% of total billed charges,11.88,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,69.2,40,,,percent of total billed charges,40% of total billed charges,5.94,138.4,
RFA LUM/SAC ADD'L RT (FLOURO INC),8900103,CDM,960,RC,64636,HCPCS,Outpatient,,,173,147.05,,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,138.4,80,,,percent of total billed charges,80% of total billed charges,11.88,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.94,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,69.2,40,,,percent of total billed charges,40% of total billed charges,5.94,138.4,
RFA OTHER PERIPHERAL NERVE LT,8900105,CDM,960,RC,64640,HCPCS,Outpatient,,,345,293.25,,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,276,80,,,percent of total billed charges,80% of total billed charges,23.06,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,138,40,,,percent of total billed charges,40% of total billed charges,11.53,276,
RFA OTHER PERIPHERAL NERVE RT,8900106,CDM,960,RC,64640,HCPCS,Outpatient,,,345,293.25,,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,276,80,,,percent of total billed charges,80% of total billed charges,23.06,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,11.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,138,40,,,percent of total billed charges,40% of total billed charges,11.53,276,
CHEMODENERVATION 1 EXT (1-4 MUSCLE),8900108,CDM,960,RC,64642,HCPCS,Outpatient,,,314,266.9,,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,197.68,190,,,Fee Schedule,pays based on BCBS Fee Schedule,197.68,190,,,Fee Schedule,pays based on BCBS Fee Schedule,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,197.68,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,197.68,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,197.68,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,197.68,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,197.68,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,197.68,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,251.2,80,,,percent of total billed charges,80% of total billed charges,37.07,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,18.53,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,125.6,40,,,percent of total billed charges,40% of total billed charges,18.53,251.2,
CHEMODENERVATION TRUCK (1-5 MUSCLE),8900109,CDM,960,RC,64646,HCPCS,Outpatient,,,344,292.4,,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,213.83,190,,,Fee Schedule,pays based on BCBS Fee Schedule,213.83,190,,,Fee Schedule,pays based on BCBS Fee Schedule,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,213.83,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,213.83,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,213.83,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,213.83,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,213.83,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,213.83,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.2,80,,,percent of total billed charges,80% of total billed charges,44.54,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,22.27,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,137.6,40,,,percent of total billed charges,40% of total billed charges,22.27,275.2,
DSTRJ BY NEUROLYTIC AGENT CELIAC PLEXUS,8900148,CDM,960,RC,64680,HCPCS,Outpatient,,,472,401.2,,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,377.6,80,,,percent of total billed charges,80% of total billed charges,29.29,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.65,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,188.8,40,,,percent of total billed charges,40% of total billed charges,14.65,377.6,
US GUIDE FOR NEEDLE PLACEMENT,8900151,CDM,960,RC,76942,HCPCS,Outpatient,,,100,85,,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,180.14,190,,,Fee Schedule,pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,pays based on BCBS Fee Schedule,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,180.14,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,80,80,,,percent of total billed charges,80% of total billed charges,6.38,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.19,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,40,40,,,percent of total billed charges,40% of total billed charges,3.19,180.14,
FLUORO GUIDE FOR NEEDLE PLACEMENT,8900152,CDM,960,RC,77002,HCPCS,Outpatient,,,87,73.95,,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,69.6,80,,,percent of total billed charges,80% of total billed charges,9.53,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34.8,40,,,percent of total billed charges,40% of total billed charges,4.76,69.6,
FLUORO GUIDE FOR NEEDLE PLACE - SPINE,8900153,CDM,960,RC,77003,HCPCS,Outpatient,,,85,72.25,,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,68,80,,,percent of total billed charges,80% of total billed charges,9.73,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.86,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,34,40,,,percent of total billed charges,40% of total billed charges,4.86,68,
ANALYSIS OF IMPLANT NEUROSTIMULATOR,8900150,CDM,960,RC,95972,HCPCS,Outpatient,,,120,102,,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,96,80,,,percent of total billed charges,80% of total billed charges,8.49,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.25,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,48,40,,,percent of total billed charges,40% of total billed charges,4.25,96,
MOD SEDATION INIT 15M >5YRS,8900154,CDM,960,RC,99152,HCPCS,Outpatient,,,37,31.45,,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,29.6,80,,,percent of total billed charges,80% of total billed charges,3.02,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,1.51,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,14.8,40,,,percent of total billed charges,40% of total billed charges,1.51,29.6,
NEW PATIENT LEVEL 2 VISIT,8900001,CDM,960,RC,99202,HCPCS,Outpatient,,,156,132.6,,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,99.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,pays based on BCBS Fee Schedule,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,99.64,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,124.8,80,,,percent of total billed charges,80% of total billed charges,8.92,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,4.46,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.4,40,,,percent of total billed charges,40% of total billed charges,4.46,124.8,
NEW PATIENT LEVEL 3 VISIT,8900002,CDM,960,RC,99203,HCPCS,Outpatient,,,234,198.9,,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,149.53,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,187.2,80,,,percent of total billed charges,80% of total billed charges,17.09,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.55,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,91.4,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.55,187.2,
NEW PATIENT LEVEL 4 VISIT,8900003,CDM,960,RC,99204,HCPCS,Outpatient,,,397,337.45,,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,pays based on BCBS Fee Schedule,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,211.34,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,317.6,80,,,percent of total billed charges,80% of total billed charges,26.24,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,13.12,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,154.58,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,13.12,317.6,
NEW PATIENT LEVEL 5 VISIT,8900004,CDM,960,RC,99205,HCPCS,Outpatient,,,517,439.45,,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,pays based on BCBS Fee Schedule,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,275.35,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,413.6,80,,,percent of total billed charges,80% of total billed charges,35.96,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,17.98,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,200.96,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,17.98,413.6,
EST PATIENT LEVEL 1 VISIT,8900005,CDM,960,RC,99211,HCPCS,Outpatient,,,45,38.25,,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,19.8,190,,,Fee Schedule,pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,pays based on BCBS Fee Schedule,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,19.8,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,36,80,,,percent of total billed charges,80% of total billed charges,1.28,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,0.64,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,18,40,,,percent of total billed charges,40% of total billed charges,0.64,36,
EST PATIENT LEVEL 2 VISIT,8900006,CDM,960,RC,99212,HCPCS,Outpatient,,,78,66.3,,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,50.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,pays based on BCBS Fee Schedule,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,50.18,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,62.4,80,,,percent of total billed charges,80% of total billed charges,6.67,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,3.34,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,30.32,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,3.34,62.4,
EST PATIENT LEVEL 3 VISIT,8900007,CDM,960,RC,99213,HCPCS,Outpatient,,,157,133.45,,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,pays based on BCBS Fee Schedule,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,88.69,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,125.6,80,,,percent of total billed charges,80% of total billed charges,11.53,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,5.76,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,60.23,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,5.76,125.6,
EST PATIENT LEVEL 4 VISIT,8900008,CDM,960,RC,99214,HCPCS,Outpatient,,,242,205.7,,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,pays based on BCBS Fee Schedule,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,112.37,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,193.6,80,,,percent of total billed charges,80% of total billed charges,16.42,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,8.21,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,93.11,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,8.21,193.6,
EST PATIENT LEVEL 5 VISIT,8900009,CDM,960,RC,99215,HCPCS,Outpatient,,,341,289.85,,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,pays based on BCBS Fee Schedule,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,186.39,190,,,Fee Schedule,Pays based on BCBS Fee Schedule,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,272.8,80,,,percent of total billed charges,80% of total billed charges,25.31,230,,,fee schedule,230%CMS Medicare physician fee schedule which is 200% Medicare rates,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,,,,,Other,Not Separately reimbursable,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,12.66,115,,,fee schedule,115%CMS Medicare physician fee schedule which is 100% Medicare rates,132.28,100,,,Fee Schedule,pays at 100% of UHC Fee Schedule,12.66,272.8,
PERQ LAMOT/LAM LUMBAR (PILD),8900157,CDM,960,RC,0275T,HCPCS,Outpatient,,,1680,1428,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1344,80,,,percent of total billed charges,80% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,672,40,,,percent of total billed charges,40% of total billed charges,672,1344,